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Bureau of Immunization Assessment & Assurance Missouri Department of Health and Senior Services.

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Presentation on theme: "Bureau of Immunization Assessment & Assurance Missouri Department of Health and Senior Services."— Presentation transcript:

1 Bureau of Immunization Assessment & Assurance Missouri Department of Health and Senior Services

2 Only 19% of Missouri’s LPHAs bill private / commercial insurance companies.

3  91.3% bill Medicaid for vaccine administration  86.1% bill Medicaid for client services  83.5% bill Medicare for client services  19.1% bill private / commercial insurance for client services Source: 2012 Infrastructure and Practices Survey

4  CDC PPHF grant received 9/2011  Stakeholder meeting 7/2012 ◦ 5 billing models identified  Availity  Health-e-Web (HeW)  Transact  UPP technology  VaxCare / VaxStation  25 LPHAs chosen to pilot billing models ◦ 11/2012 to 4/2013  Insurance Summit 7/2013  Toolkit printed & mailed 9/2014

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6 Billing will allow LPHAs to identify and tap into existing sources of revenue to survive, even thrive, through though economic times when people often need care most.

7  Business Process A business analysis should be conducted in order to determine the LPHAs needs.

8  Standard Client Survey  How old is the individual requesting the vaccine today?  What is the individual’s county of residence?  Why was the LPHA chosen to get a vaccine?  What kind of insurance does the individual currently have?  Was the individual immunized today?

9  Cost Assessment ◦ It is important that the benefits of billing for services outweigh the cost and effort of billing.  Networking will give LPHAs who would like to bill the opportunity to gain best practices and tips from those who are already billing.

10 The use of a billing model can greatly simplify the billing process.

11  Clearinghouse ◦ An intermediary between billing staff and third- party payers  Billing Software ◦ Implements the billing process and assists with the management of day-to-day operations of the agency.  Immunization Service Provider ◦ Provides vaccines, claims processing and patient billing.

12  Availity ◦ Web-based clearinghouse with no set-up, monthly or per-claim fees for basic services ◦ LPHA must have contracts with private / commercial insurance companies  HeW (formerly Health-e-Web) ◦ Web-based clearinghouse with no set-up fees and a $79 monthly fee with unlimited transactions ◦ LPHA must have contracts with private / commercial insurance companies

13  TransactRx ◦ Web-base clearinghouse with no set-up fees. Charges up to $1.50 per claim fee, which is not paid until the claim is paid by the insurer ◦ LPHA must have contracts with private / commercial insurance companies (company will assist with this)  Upp Technology ◦ Billing software for eligibility verification, claims processing and revenue management on a transactional fee basis ◦ Costs for software set-up $200-$500 each. Per claim fees are also charged ◦ LPHA must have contracts with private / commercial insurance companies

14  VaxCare ◦ Third-party immunization service provider that offers vaccines, claims processing and patient billing ◦ Monthly fee of $75 for immunizations administered for the month or $150 for 0-29 immunizations administered for the month ◦ Vaccines & supplies are ordered on an as needed basis at no cost ◦ LPHAs are compensated $10 per immunization for all vaccines excluding influenza, which is compensated at $8 per dose

15  Assessing and confirming the qualifications of a licensed or certified health care practitioner  A credentialing application along with supporting documentation must be submitted to the insurance company  Must be credentialed prior to insurance companies paying claims

16  The contract is used to accomplish the following: ◦ Establish a legal relationship ◦ Define your responsibilities ◦ Establish the claim filing process ◦ Detail the procedure for payments ◦ Define the fee schedule ◦ Detail regarding co-payments, deductibles, etc.

17 Although the billing process can be challenging, it is worth the effort to improve the LPHAs sustainability.

18  Where will staff perform billing tasks? ◦ Reception desk should be isolated for privacy  Mobile clinics?  Off-site locations?  Personal computer  Internet access

19  Receptionist /Intake Specialist ◦ Greeter, collects info, scans cards, gets client signatures, collects forms, & collects payments  Credentialing Specialist ◦ Takes care of all credentialing activities  Billing Specialist ◦ Processes all claims

20  Written policies and procedures are vital to the success of billing and should be carefully developed to include all aspects of the process

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22 Billing is the bridge between improving access to care for clients and expanding partnerships between LPHAs and the larger health care system.

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27  Advantages  Disadvantages  Is the billing model sustainable?  Would you recommend this billing model to other LPHAs?  Additional information

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31  LPHA identified barriers & solutions

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