A Third Party Billing Success Story How a Small, Rural Public Health Department is Generating Significant Revenue Through Immunization and HIV Billing Kara A. Davis, RN, BSN Assistant Administrator/Director of Nursing at Logan County Department of Public Health Tara Comstock Support Services Supervisor/Finance Billing Specialist at Logan County Department of Public Health
Objective of this Webinar The objective of this webinar is to demonstrate how a small rural health department can successfully generate revenue through third party billing, particularly through billing for immunizations, HIV testing, and related services.
Webinar Outline 1. Billable Services 2. Pricing and Billing 3. Medicare Part D 4. The Payers 5. Medicare Part B 6. Marketing and Community Outreach 7. STD Clinic 8. Billing for HIV Testing and Related Services 9. Tracking and Reporting 10. Questions
Billable Services Offered at Logan County Health Department Immunizations to everyone birth-100, private pay, Medicare and Medicaid STD testing HIV Testing Blood Lead Testing Hemoglobin Testing TB Testing Pregnancy Testing Urine collection for drug screens
Pricing and Billing Blue Cross Blue Shield update price list yearly VFC--Always charge the state paid rate $23.87 TransactRx Check eligibility, either thru CDP and/or Medi. This will make sure you are using the correct vaccine and getting paid. Credentialed with all major insurance companies including Medicare Part B
Billing Medicare Part D With TransactRx Submit Claims for all Medicare Part D covered vaccines with one contract Simple Web-Based Solution No Software to Install No Billing or Coding Experience Needed No cost to you for billing of Medicare Part D Since March of 2015 we have gotten $10,790 from using TransactRx
Insurance Companies We are credentialed with: Blue Cross Blue Shield Medicare Health Alliance Molina Aetna Tri-Care Meridian Cigna Coventry Humana United Health Care Medicaid
Medicare Part B 2016-2017 flu season we recouped $44,114.13 from Medicare Part B for flu shots 2015 2016 we received $73,702.16 for pneumonia 23 and Prevnar 13 2016 2017 we received $40,183.17 for pneumonia 23 and Prevnar 13
Marketing Press releases Facebook Website Flyers at all local events Newsletter quarterly Employees Have Family members get vaccines at the HD Bill employees insurance for services at HD (Flu shot, TB test, etc...). In the 2016 flu season we recouped $768 from employee flu shots.
Community Outreach Local business (Wal-Mart, a local factory, Dollar General) Drug screens Local hospitals Tdap clinic in the OB unit Colleges STD clinics Back to school shot clinic Local Senior Center/Assisted Living Flu clinic Police station/other county owned business (courthouse, highway department) Flu clinics Drug screens
STD Clinic Bill insurance/medicaid Ask for donations from clients IPHA HIV grant
IPHA HIV Grant IDPH is supplying free HIV test kits to agencies conducting HIV testing on the regional HIV prevention grant. IDPH is supplying free Lab processing of HIV specimens sent to the State Lab on the regional HIV prevention grant. IDPH is reimbursing agencies that conduct HIV testing on the regional HIV prevention grant for the cost of administering the test through the Fee-for- Service reimbursement process. The regional HIV prevention grant is reimbursing $100 to $150 for HIV tests.
HIV Billing Guidelines HIV tests can be performed and billed to any insurance company regardless if it is a Medicaid/MCO plan or a commercial/private plan. Medicare will not reimburse for any HIV services since the Public Health Department is only enrolled as a Roster Bill with Medicare. The above only applies if you are not sending to the state lab.
National Alliance of State & Territorial AIDS Directors (NASTAD) NASTAD is a member of the CBA Provider Network and has a long history of providing technical assistance and Capacity Building Assistance (CBA) to health departments to support HIV testing. https://www.nastad.org/resource/billingcoding-guide-hiv-prevention
Monthly Billing Statements from Dedicate a person to go over these every month CDP
Reports Run reports at least monthly Claims on hold Pending claims Services never billed Balance aging report (run years separately) E-mail questions to EzEmrx
Questions?