Welcome. Revenue Cycle

Transcription

1 Welcome 1 Statewide Immunization Meeting Immunization Billing Exchange Provide immunization fiscal staff of LHDs an opportunity to meet to share best results, lessons learned, barriers encountered in trying to bill for immunization, and way to remove barriers or work around them. Todays Agenda: 9:15 12:00 1) Overview of Elements for Successful Immunization Billing Practice 2) County updates on the project 3) Break 4) Round table discussion on successes and barriers 5) Meeting evaluation Revenue Cycle 2 Front End Intermediate Back End Scheduling & Information Registration Forms Insurance Verification VFC Eligibility Fee Determination Sliding Fee Scale Charge Data Capture Medical Coding NYSIIS Data Entry Claims Processing Explanation of Benefits Remittance Posting Claims Follow-up Adjustments Patient Balance Collection 1

2 The foundation of successful billing: 3 1. Information System Capacity: LHDs need an information system or service 2. Third party relationships: To obtain reimbursement for immunizations provided to enrolled patients, LHDs need to develop relationships with insurance plans 3. Workforce Capacity and Capability: LHDs need sufficient personnel resources 1. Information System Capacity Health Information Systems Requirements Practice Management Information Systems Electronic Health Record Reporting Capabilities 2. Third Party Relationships Medicare and Medicaid enrollment Provider contracts External billing functions: Clearinghouse and Outsourcing 3. Workforce Capacity Schedule and register patients Billing and collections Electronic funds transfer enrollment Contracting and credentialing Manage revenue cycle processes IT support for software implementation, maintenance and trouble shooting. 2

3 1. Information System Capacity: 5 LHDs need an information system or service that can provide: Single-point patient data entry Useful for multiple clinical service areas within an LHD Efficient NYSIIS data transmission Electronic claim submission Availability of service data for billing functions Account reconciliation Financial and statistical reporting capabilities Data import and export capabilities 2. Third party relationships: To obtain reimbursement for immunizations provided to enrolled patients, LHDs need to develop relationships with insurance plans, including: 6 Network agreements with insurance plans Credentialing of LHD practitioners with insurance plans so that LHDs can be reimbursed as network providers Outsource agreements to enable streamlined LHD communication with payers Clearinghouse Billing company Community partnership 3

4 3. Workforce Capacity and Capability: 7 LHDs need sufficient personnel resources to: Handle scheduling and registration Submit claims, post payments and address outstanding accounts Handle electronic claims, enrollment process and submit paperwork for electronic funds transfer (EFT) deposits from payers Manage the health plan contracting and credentialing effort Handle IT support for software implementation, maintenance and troubleshooting How is this going to get done? 8 Discuss strategies Fee for services Contracting Renegotiate administration fees Out sourcing Develop action plans Request grant funds (if needed) Educate staff Implement processes Staff support 4

5 Reminder: You can bill the Administration Fee to Medicaid Managed Care Organizations (MCO s) without a contract: Submit the claim 9 Follow the claim Follow up with MCO customer service They are required to pay the State defined rate for services since you have no contact and are an LHD Strategies: All patients must be treated Talk tracks a fee maybe charged No insurance Refer to Facilitated enroller Public insurance Commercial insurance Data collection Insurance verification Set/Reevaluate Administration fee Sliding fee schedule Waivers case by case bases with Directors approval 10 5

6 Action Plan: 11 Scheduler Verification Claims Payments Reporting Grant Funding: What to ask for: Software purchase and startup costs Contractual agreements for billing improvement (includes consultant services) Contractual agreements for billing services: Clearinghouse Insurance Verification Billing Service IT infrastructure to support billing Training 12 6

7 Resources 13 NYSACHO website members only Discussion forum Useful documents General information and forms Additional resources listen to CDC and NYSACHO Webinars and Teleconferences Contracting links NACCHO website national toolkits Forum Discussion Topics TB Testing Medicaid reimbursements for interpreters Cost for vaccines what to bill Lead draws transactrx-medicare D billing Billing Medicare Part D through Advantage Plans APG Fee schedule VFC Admin Billing STD billing law Contracts with Insurance Companies Third party billing organizations information request Creative ways of increasing revenue opportunities 14 Co-pays Health Facility cash assessment programs FYI State in Forum Billing software VFC administration fee 1500 form need to be signed by our Medical Director Patient sign a consent form for billing insurance companies Proper way to bill for an administrative fee only Immunization billing receipts Medicaid billing for adult and VFC vaccines Rabies post exposure billing 7

8 Functionality of Forums 15 Conclusion 16 Customize a billing solution that works for your county executives, management, staff and residence. 8

9 Questions and Answers 17 9