AGENDA. Join the conference call: Dial In ; Code

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1 AGENDA KDHE-KALHD Public Health and Medicaid Advisory Group Planning, Policy Development and Coordination of Public Health Services with KS Medicaid Population August 8, 2014, 10:00am -- Noon Please join the meeting: Join the conference call: Dial In ; Code Workgroup Purposes (Overall Purpose): In order to increase the effectiveness and efficiency of Kansas Medicaid services, this workgroup is designed to help guide the planning, policy development, and coordination of services of KDHE (Kansas Department of Health & Environment), KALHD (Kansas Association of Local Health Departments), local health departments, and others interested in public health services for the Kansas Medicaid population. 10:00-10:05 Gathering & Introductions 10:05 10:20 Updates: Leadership, Oral Health Kansas, Health Homes, Kansas Accreditation Readiness Project 10:20 10:40 Immunizations Billing Project Update Stephanie Lambert, KFMC Questions and Discussion 10:40 11:00 Billing Identification of System Challenges (Dissatisfaction) AAron Davis DxVxFS>RC What haven t we captured? Do you agree that these are concerns? 11: :10 Vision Potential Solutions AAron Davis 11: :45 First Steps What are the feasible next steps? ALL The Advisory Group s expertise is needed to guide appropriate next steps. 11:45 Other Announcements: VISTA, As May Arise Noon: Adjourn

2 Public Health and Medicaid Advisory Group August 8 th,

3 Agenda Workgroup Purposes (Overall Purpose): In order to increase the effectiveness and efficiency of Kansas Medicaid services, this workgroup is designed to help guide the planning, policy development, and coordination of services of KDHE (Kansas Department of Health & Environment), KALHD (Kansas Association of Local Health Departments), local health departments, and others interested in public health services for the Kansas Medicaid population. 10:00-10:05 Gathering & Introductions 10:05 10:20 Updates: Leadership, Oral Health Kansas, Health Homes, Kansas Accreditation Readiness Project 10:20 10:40 Immunizations Billing Project Update Stephanie Lambert, KFMC Questions and Discussion 10:40 11:00 Billing Identification of System Challenges (Dissatisfaction) AAron Davis DxVxFS>RC What haven t we captured? Do you agree that these are concerns? 11: :10 Vision Potential Solutions AAron Davis 11: :45 First Steps What are the feasible next steps? ALL The Advisory Group s expertise is needed to guide appropriate next steps. 11:45 Other Announcements: VISTA, As May Arise Noon: Adjourn 2

4 3 Updates

5 Leadership West Cohort -- Hays Still have openings Deadline to apply is Aug 15 September 4-5 October 6-7 October December 8-9 Central Cohort -- Wichita November December January February

6 Oral Health Kansas Still waiting on follow up from discussions in early summer. Potential opportunity for LHDs to serve as sites where ECP III Dental Hygienists provide services. 5

7 Health Homes State Plan Amendment #1 Serious Mental Illness Was approved last week by CMS Assignment letters sent in July with services beginning Aug. 1 Weekly implementation calls with KDHE on 10:00 a.m. State Plan Amendment #2 Chronic Conditions Delayed due to lack of sufficient network Gathering data to determine if there can be a regional rollout prior to January 2015 Targeted recruitment of Primary Care Providers (clinics, etc.) Weekly update calls with KDHE on noon 6

8 Health Homes MCOs still in contracting process 5 LHDs currently contracted with one MCO (not all the same MCO) Health Action Plan Training First webinar tentatively scheduled for Sept. 10:00 a.m. Topic: SMART Goal writing Care Coordinators/Managers Learning Collaborative Hoping to begin in September 7

9 Kansas Accreditation Readiness Project Monthly electronic meeting via Adobe Connect Third Thursday of each month from 1-4pm Support from Americorps VISTA Austin Burke Designed with evaluation in place during each meeting Currently working on Domain 3 17 LHDs are participating 8

10 Medicaid Administrative Claiming (MAC) Presentation at KALHD Mid-Year in June KDHE is following up with other states about their implementation process Additional research being conducted One proposal considered: start with the big five 9

11 10 Medicaid Billing Project

12 KFMC Immunization Grant Turning screen over to Stephanie Lambert, KFMC Project Manager 11

13 Outline of Discussion Research and evaluation Analysis of barriers and dissatisfaction Creating a shared vision for the future Possible solutions to explore & evaluate 12

14 Research Six interviews over billing processes Discussion with CCSR advisory group KDHE Immunizations Grant (2011) KFMC 2012 and 2014 Billing survey KFMC development of barriers identified by LHDs 13

15 14 Medical Billing Workflow

16 D x V x F > R C Change occurs when: Dissatisfaction x Vision x First Steps is greater than Resistance to Change 15

17 Identified Dissatisfaction 1. Medicaid claiming & billing complexities 2. Limited staff time to dedicate to billing 3. Staff turnover & aging workforce 4. Tracking and handling denials is a difficult task 16

18 Identified Dissatisfaction (cont.) 5. CPT codes and modifiers change annually - CY13 LHDs used 560+ CPT codes 6. ICD-10 readiness - CY13 LHDs used ICD-9 codes 7. Lack of focus on business practices 8. Billing rates 9. Contract negotiations 10. Contract management 17

19 Vision Billing & Coding Manual LHD Specific Billing & Coding Training Business Practice Training Practice Management Solution and/or Electronic Health Record systems (EHR) Outsource of Billing Hybrid EHR/Billing Systems Centralized Billing Centralized Contracting 18

20 Feasibility of Implementation Ease of Implementation vs Efficiency Not easy to imp. Extremely easy to imp. Not efficient Extremely efficient Long-term efficiency for solving problem 19

21 Feasibility of Implementation Not Feasible Feasible Enhancing Revenue for Services Centralized Hybrid Billing Training PMS/EHR Outsource Manual EHR/outsource Training Biz Contrac Billing Prac Feasible Not efficient Feasible Efficient Not feasible Not efficient Efficient Not feasible Not Efficient Efficient 20 Long-term efficiency for solving problem

22 Feasibility of Implementation Not Feasible Feasible Enhancing Revenue for Services Feasible Not efficient Low-hanging fruit Put on backburner Feasible Efficient Move forward with Not feasible Not efficient Will stop considering Efficient Not feasible Research to increase feasibility Not Efficient Efficient 21 Long-term efficiency for solving problem

23 22 Questions?

24 Strategic Planning to Support Local Health Department Billing Stephanie Lambert-Barth, PMP Project Manager August 8, 2014

25 Project Objectives 1. Assess, then implement or expand, local health department (LHD) billing of private insurers for immunization services. 2. Demonstrate how revenue streams may be expanded through billing immunization services for privately insured clients. 3. Better understand LHD billing capabilities.

26 Project Objectives 4. 4.Estimate the potential return on investment Identify and address the barriers for LHDs who want to implement or expand billing programs Develop a strategic plan Pilot test, assess and refine the strategic plan.

27 Project Plan Work with stakeholders to identify barriers Conduct surveys of LHDs Collect data about the current billing environment Describe existing environment and available resources Coding training and certification pilot project Develop and test a statewide strategic plan

28 Stakeholder Group Immunization Billing Stakeholder Group- Local Health Department Participants Updated 4/3/2014 Rawlins Norton Brown Doniphan Thomas Rooks Clay Pottawatomie Jackson Atchison Geary Shawnee Wyandott Logan Gove Dickinson Douglas Johnson Barton McPherson Lyon Osage Franklin Finney Hodgeman Pawnee Coffey Anderson Edwards Reno Greenwood Woodson Allen Bourbon Wilson Comanche Barber Harper Sumner

29 Stakeholder Group Insurer Participants Blue Cross Blue Shield of Kansas Blue Cross Blue Shield of Kansas City United Healthcare Organizational Participants Kansas Department of Health and Environment Wichita State University Center for Community Support & Research Kansas Assn. of Local Health Departments (KALHD) Kansas Health Information Mgmt. Assn. (KHIMA) Physician Groups (KMS, AAP, KAOM, KAFP)

30 Billing Resource Website The stakeholder group requested a web-based location for project documents and resource materials for use throughout the project KFMC developed a resource website, currently at The website has been updated on a routine basis since its creation. The website will be transitioning over to KDHE s website within the next few weeks. Quarterly review and maintenance of this website is recommended.

31 LHD Billing Barriers There are not sufficient existing training resources, specific to the billing needs of public health clinics. Availability of accessible, affordable training resources is a barrier. At the time of the billing survey response, 99% of Kansas LHDs reported they do some level of insurance coverage verification. However, LHDs have reported experiencing challenges with the verification process.

32 LHD Billing Barriers Kansas LHD billing staff reported varying insurance company requirements can be a barrier. Interpretation of billing response information from insurers is challenging. Attaining full in-network participation status can be a barrier. Start-up costs can be a barrier, especially as it relates to adopting products and technology needed to succeed.

33 Training/Certification Pilot Project Four pilot participants (Douglas, Harper, Reno, Sumner) were selected through an RFP process Each pilot participant was provided with updated coding manuals and a training budget Baseline data was collected before training started Training activities occurred 11/1/2013-4/30/2014 Re-measurement data was collected in June 2014

34 Training/Certification Pilot Participant Comments Two participants were near completion of the training in late June Two participants had completed around 50% of content and still planned to complete the training over the next few months Generally, participants reported the training was personally beneficial. However, much of the content was not relevant to health department billing Three health departments reported learning new information that could lead them to make local changes in codes used for billing

35 Kansas Billing Resources Action Plan Health Department Billing Training Health Department Billing Resource Manual Support Services for Health Department Billing Product Adoption Health Department Billing Resource Website Regional Billing Group Support

36 For More Information Contact: Stephanie Lambert-Barth, PMP Kansas Immunization Billing Project Project Manager, Contractor (785)