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Kansas Local Health Department Billing Project March 2014 Stakeholder Meeting

Kansas Local Health Department Billing Project March 2014 Stakeholder Meeting. Presented to:. Kansas Immunization Billing Stakeholder Group March 20, 2014. Meeting Agenda. Welcome, Introductions and Meeting Overview Training/Certification Pilot Project Updates CDC Revenue Data Request

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Kansas Local Health Department Billing Project March 2014 Stakeholder Meeting

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  1. Kansas Local Health Department Billing ProjectMarch 2014 Stakeholder Meeting

  2. Presented to: Kansas Immunization Billing Stakeholder Group March 20, 2014

  3. Meeting Agenda • Welcome, Introductions and Meeting Overview • Training/Certification Pilot Project Updates • CDC Revenue Data Request • 2014 Billing Survey • Kansas Billing Successes, New Barriers and Billing Opportunities for Kansas Providers (Open Discussion) • The Future of LHD Billing in Kansas • Closing Comments and Meeting Conclusion

  4. Welcome, Introductions and Meeting Overview • Who is in the room today? • Who is on the phone/webinar today? • Use of the chat function in the Webinar software to make it easier for remote participants to comment and participate.

  5. Training/Certification Pilot Project Updates • Based on what you've learned through the training process, have you identified any issues in your current billing processes? • Have you considered or made changes to any local billing processes as a result of what you've learned so far?

  6. Training/Certification Pilot Project Updates • How has working on this type of training during your work day affected your office routine? • What accommodations would you suggest health department managers consider to help their billing staff be successful if they pursue this type of training?

  7. Training/Certification Pilot Project Updates • Do you plan to take the certification exam that is associated with the training you are taking? • Would you recommend the training you are taking to your peers at other Kansas LHDs?

  8. Training/Certification Pilot Project Updates • Other questions for the pilot participants? • Additional comments from the pilot participants?

  9. Training/Certification Pilot Project Next Steps • KFMC will continue to monitor training activities through April 30, 2014. • Pilot project re-measurement data will be collected in early June. • Pilot project measurement results will be shared and discussed at our next stakeholder meeting, and will be included in the strategic plan report.

  10. CDC Revenue Request • Our CDC partners have shared more information about their expectations for reporting of LHD revenue from billing. • Some of our discussion items during “The Future of LHD Billing in Kansas” are intended to help us capture some of the needed information. • Additional survey questions have been added to capture needed details.

  11. 2014 Billing Survey We have the draft version of the survey ready to share. The survey questions fall into the following categories: • About the Respondent • Contracting and Credentialing • About Your Billing Staff • Client Insurance Coverage • Experience with Insurance Billing • Billing Outcomes and Revenue • ICD-10 Readiness • Immunization Services

  12. 2014 Billing Survey • About the Respondent 1. Please indicate the county or counties your health department serves. County Name: __________________________ 2. Which staff assisted you in collecting information needed to respond to this survey? (check all that apply)  Administrator completed the survey with no staff assistance  Nurse  Receptionist  Medical Director  Medical Records  Billing Clerk  Other (please specify) ______________________________________________________

  13. 2014 Billing Survey • Contracting and Credentialing 3. IN THE LAST YEAR, has this health department attempted to CONTRACT with any private insurers in order to bill its services? Note: Contracting refers to entering a business agreement with the insurance company for the purpose of being able to bill services.  Yes  No 4. Please describe any barriers this health department encountered IN THE LAST YEAR regarding CONTRACTING. ______________________________________________________________ ______________________________________________________________

  14. 2014 Billing Survey • Contracting and Credentialing (continued) 5. IN THE LAST YEAR, has this health department attempted to CREDENTIAL with any private insurers in order to bill its services? Note: Credentialing refers to meeting the standards set by the insurance company to enroll as an in-network provider.  Yes  No 6. Please describe any barriers this health department encountered IN THE LAST YEAR regarding CREDENTIALING. ______________________________________________________________ ______________________________________________________________

  15. 2014 Billing Survey • About Your Billing Staff 7. How many billing staff work at this health department?  None ( If none, go to question 12 )  1  2  3 or more If this health department has more than three billing staff members, please respond for the staff members with the MOST experience. If less than three billing staff members, leave the extra lines blank. 8. For each billing staff, how much billing experience? Years 0-6 Months 7-12 Months 1-2 Years 3-5 Years 6+ Staff Member #1     Staff Member #2     Staff Member #3    

  16. 2014 Billing Survey • About Your Billing Staff (continued) 9. For each billing staff, how much formal training? None 1-7 Hours 1-4 Days 1-2 Weeks > 2 Weeks Staff Member #1     Staff Member #2     Staff Member #3     10. For each billing staff, is this a certified coder? Yes No Staff Member #1   Staff Member #2   Staff Member #3   11. Does your billing staff currently participate in a regional billing group?  Yes  No

  17. 2014 Billing Survey • Client Insurance Coverage 12. Does this health department verify insurance coverage at the time of service?  Yes  No. Please specify why this health department does not verify coverage. ______________________________________________________________ ______________________________________________________________ 13. What percentage of clients served by this health department, in each of the following age groups, is covered by public health insurance (Medicare or Medicaid)? 0-25% 26-50% 51-75% 76-100% Unknown Ages 0 - 6     Ages 7 – 18     Ages 19 – 64     Ages 65+    

  18. 2014 Billing Survey • Client Insurance Coverage (continued) 14. What percentage of clients served by this health department, in each of the following age groups, is covered by PRIVATE health insurance? Note: For LHDs using KIPHS software, one possible source of data for this question is the report titled “VFC Eligibility Report for State and for Private.” Please use the best available source of information to formulate your response. Ages 0 - 6 ______% Ages 7 - 18 ______% Ages 19 - 64 ______% Ages 65+ ______% Comments ______________________________________________________________ ______________________________________________________________

  19. 2014 Billing Survey • Experience with Insurance Billing 15. Does this health department currently bill ANY private insurers?  Yes  No If no, please specify why not. ______________________________________________________________ ______________________________________________________________ 16. Does this health department bill ALL private insurers?  Yes  No. Please specify which insurers are not billed and the reasons. ______________________________________________________________ ______________________________________________________________

  20. 2014 Billing Survey • Billing Outcomes and Revenue 17. On average, how many minutes of staff time does it take for this health department to process and submit an insurance claim for health department services? Enter minutes as a whole number _____________ 18. In calendar year 2013, what percentage of insurance claims that this health department submitted were initially denied? Enter percent as a whole number 0 - 100 _____________ 19. In calendar year 2013, what percentage of insurance claims that this health department submitted were denied due to client eligibility issues? Enter percent as a whole number 0 - 100 _____________

  21. 2014 Billing Survey • Billing Outcomes and Revenue (continued) 20. Are denied claims rebilled?  Yes  No 21. What percentage of your agency’s billing time is spent rebilling denied claims? Enter percent as a whole number 0 - 100 _____________ 22. In calendar year 2013, how much billing revenue did your agency receive from Medicare? Enter dollar amount as a whole number _____________

  22. 2014 Billing Survey • Billing Outcomes and Revenue (continued) 23. In calendar year 2013, how much billing revenue did your agency receive from Medicaid/SCHIP/KanCare? Enter dollar amount as a whole number _____________ 24. In calendar year 2013, how much billing revenue did your agency receive from private insurers? Enter dollar amount as a whole number _____________ 25. Comparing your calendar year 2013 total billing revenue (from all sources) to your calendar year 2010 billing revenue, have your revenues from billing increased or decreased?  Our revenue from billing increased between 2010 and 2013  Our revenue from billing decreased between 2010 and 2013

  23. 2014 Billing Survey • Billing Outcomes and Revenue (continued) 26. How much did your revenue increase or decrease between 2010 and 2013 Enter percent as a whole number 0 - 100 _____________ 27. Please comment about the reasons for these changes in your billing revenue between 2010 and 2013. ______________________________________________________________ ______________________________________________________________ 28. For claims billed in the first quarter of calendar year 2014, please describe any barriers this health department encountered when billing. ______________________________________________________________ ______________________________________________________________

  24. 2014 Billing Survey • Billing Outcomes and Revenue (continued) 29. Which of the following services do you bill to private insurers? (check all that apply)  Immunizations  Maternal and infant health  Sexually transmitted disease screening  Well child visits  Other (Please specify additional services you bill) ______________________________________________________________ ______________________________________________________________ 30. Does this health department use billing software?  Yes  No Please specify the name of the billing software product and the vendor. ____________________________________________________________

  25. 2014 Billing Survey • Billing Outcomes and Revenue (continued) 31. Does your agency currently do all billing internally or do you rely on external resources for submitting claims (check all that apply)?  We do all our own billing  We use a billing service  We work with a clearinghouse  We partner with other health departments for billing  We partner with other providers in our community for billing Please specify the billing service ____________________________________________________________ Please specify the clearinghouse vendor. ______________________________________________________________

  26. 2014 Billing Survey • ICD-10 Readiness 32. Does your agency currently use ICD-9 codes in defining diagnoses for clients?  Yes  No 33. What is your agency’s current knowledge level on ICD-10 codes (i.e. even if you are not fully knowledgeable, is there someone in your agency who will serve as a resource)?  1 (no knowledge)  2 (minimal knowledge)  3 (some knowledge)  4 (fairly knowledgeable)  5 (fully informed and understand ICD-10 codes and implementation needs)

  27. 2014 Billing Survey • ICD-10 Readiness (continued) 34. How prepared is your agency to make the transition to ICD-10 codes?  1 (have not yet started to prepare)  2 (minimal preparation)  3 (some preparation)  4 (fairly extensive preparation)  5 (fully prepared) 35. What types of training have you or your agency done to prepare for ICD-10? (check all that apply)  Training of billing staff  Training of nurses/clinicians  Training of administrators/managers

  28. 2014 Billing Survey • ICD-10 Readiness (continued) 36. What other types of activities have your or your agency done to prepare? (check all that apply)  System/product updates  Clinical documentation assessment  Redesign of billing forms  Transaction testing  Contingency planning  Networking with other health departments  Networking with hospital or clinic for sharing information  We have not begun to prepare for ICD-10 code usage

  29. 2014 Billing Survey • ICD-10 Readiness (continued) 37. If you use a billing service or clearinghouse, will they be prepared for the ICD-10 transition?  Yes  No 38. October 1, 2014 is the compliance date to begin submitting ICD-10 diagnosis codes on claims. Will you be prepared to submit ICD-10 codes by this date?  Yes  No 39. What resources or support would be helpful for your agency prepare for the ICD-10 transition? ______________________________________________________________ ______________________________________________________________

  30. 2014 Billing Survey • Immunization Services 40. Is this health department the sole source for immunizations in this county? Yes No Unknown For children:    For adults:    41. What percentage of this county's immunizations are currently administered by other providers in your community? 0-25% 26-50% 51-75% 76-100% Unknown Ages 0 - 6     Ages 7 – 18     Ages 19 – 64     Ages 65+     Comments ______________________________________________________________ ______________________________________________________________

  31. Billing Project Presentation Break- 15 Minutes

  32. Successes, Barriers and Opportunities • Kansas Billing Successes, New Billing Barriers and Billing Opportunities for Kansas Providers • LHD participants, please share your billing success stories and new barriers you have encountered. We need open dialogue about what is and what is not working. • Please keep in mind everyone in the room is interested in helping reduce issues and solve problems that are shared. We will not have time to provide answers and solve problems during the meeting discussion today. Every effort will be made to provide timely feedback regarding issues discussed, as a follow-up item.

  33. The Future of LHD Billing in Kansas • Content of LHD-specific billing training to meet the needs of multiple LHD staff roles • Who needs additional training and resources? Billers? Administrators? Clinicians? Others? • What are the needs for each role? • List of common ICD-9 and CPT codes used by Kansas LHD providers

  34. The Future of LHD Billing in Kansas • Recommendations for content and format of LHD-specific billing resource manual

  35. Billing Project Presentation Break/Lunch- 15 Minutes Discussion to continue as we eat lunch

  36. The Future of LHD Billing in Kansas • Incorporating LHD specific case studies in training and reference materials • Share list of case study recommendations and expand the list as appropriate

  37. The Future of LHD Billing in Kansas • Improving regional billing group supports and structure

  38. The Future of LHD Billing in Kansas • Centralization of billing as a strategy to improve outcomes • Discuss the Kentucky example

  39. The Future of LHD Billing in Kansas • Outsourcing of LHD billing as a strategy to reduce costs and improve outcomes

  40. The Future of LHD Billing in Kansas • Measuring and monitoring billing outcomes at the system level

  41. The Future of LHD Billing in Kansas • Local measurement and monitoring of billing statistics at the LHD level. How can the LHD use metrics determine if their billing outcomes are adequate?

  42. Pilot Project Measures and Baseline Results

  43. The Future of LHD Billing in Kansas • Are changes needed in the legal environment for LHD billing? Some states have pursued legislative changes that require insurance companies to pay public health providers at contracted provider reimbursement rates, and have reduced and/or eliminated the need for LHDs to go through formal contracting and credentialing processes.

  44. The Future of LHD Billing in Kansas • LHD revenue trends- What changes have LHDs observed in payments from private insurers, Medicaid and Medicare between 2011 and 2014?

  45. The Future of LHD Billing in Kansas • LHD billing costs- What changes have LHDs observed in the costs to bill for services between 2011 and 2014?

  46. Upcoming Billing Project Activities

  47. Closing Comments and Meeting Conclusion

  48. For More Information Contact: Stephanie Lambert-Barth, PMP Kansas Immunization Billing Project Project Manager, Contractor (785)-271-4137 slambert@kfmc.org

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