CA Public Health Billing Project Billing Workgroup September 25, 2012

Many Public Health services have been provided free of charge Historically Many Public Health services have been provided free of charge ddd The State supplied Vaccine and we, as public health didn’t think of the cost. There weren’t as many required vaccines and they weren’t as expensive. Health Departments were expected to be the safety-net for all health care that individuals were not able to get elsewhere We didn’t think about charging people.

Through the years… Costs of Services Pneumococcal 360% Flu Varicella Rotovirus MMR DTP Polio MMR DTAP Polio As the years have gone by: Just a few vaccines have turned into dozens Cost to purchase recommended vaccines for children increased 360% within the past 10 years HIB Pentacel HEP B Meningococcal

Insurance Benefits I paid my insurance for vaccines. At Public Health, I gave her a vaccine for free. Insurance Companies Privately insured patients paid premiums to private insurance companies and the cost of vaccines were covered. We give the vaccine for free which means the insurance company are not having to pay for service they are supposed to provide and insured patients are paying for . I paid my insurance for vaccines. I kept the money and didn’t have to pay for her vaccine.

Services are free at the Health Department! TODAY Services are free at the Health Department! Some Health Departments understand that they can no longer continue to provide all services with government dollars and have started to look into the concept of billing Medicaid, Medicare and private insurance Health Departments will not survive economically if they continue to give away services that are otherwise covered by private insurance

Planning Grants NYC 14 Grantees Funded Through ARRA-317 Innovative Projects to Improve Reimbursement in Public Health Department Clinics Duane Kilgus; CDC Stakeholder Meeting, February 1, 2012

CA Insurance Landscape Civilian, non-institutionalized population, 81.5% have health insurance coverage. Over 6.8 million Californians have no health insurance coverage. Of those with insurance, 54.4% is provided through an employer, 17.7% are covered by Medicaid (Medi-Cal), and 7.5% are covered by Medicare. Of those under the age of 18 years, 9.0% have no health insurance coverage.

Kern’s Process Updated Fee Schedule Initiated Private Insurance Contracts Provider Credentialing Enhanced Insurance verification Improved Coding & Medical documentation Developed better Clinic Flow and Staff placement Currently contracted with Medi-Cal, Medicare, Blue Shield. TriWest and Humana are at the in Credentialing.

Kern’s Billing Toolkit Several states have requested copies Many places are using it! Mendocino county is using the manual. Maricopa county in AZ is using it as well as Michigan. Dozens of people worked for hundreds of hours to make this manual a success. Because of that, we were awarded the Implementation grant.

Implementation Grants Additional Planning Grants NYC After the success of the initial 14 Planning Gants, the CDC decided to further fund implementation grants. 7 States received the implementation grant and 16 new states received implementation grants. Recently, the CDC has funded an additional 7 states for the implementation grant and an additional 15 for the Planning grant. Houston Planning Implementation Duane Kilgus; CDC Stakeholder Meeting, February 1, 2012

Implementation Process Seven CA counties selected to participate On-site training with each site Post-training consultation Billing workgroup for the counties Webinar training Humboldt San Joaquin Mendocino Madera Contra Costa Tulare 8 were interviewed and invited to participate. 1 chose not to participate at this time (Los Angeles). 1 chose to participate by using our manual, and contacting us for clarification (Mendocino). 6 have chosen to fully participate with a week long hands-on training. Long Beach

Plans for Implementation “Stay with me now, people, because in step C, things get a bit delicate.”

Training Team Athina Kinsley Timi Granados On the road, again! Health Insurance Specialist kinsleya@co.kern.ca.us (661) 868-0207 Timi Granados Administrative Coordinator granadost@co.kern.ca.us (661)868-0334 On the road, again!

Training Schedule San Joaquin May 14 – 18 Madera June 18 -22 Long Beach July 9 – 13 Humboldt August 6 – 10 Tulare Sept. 17 -20 Contra Costa Oct 22 - 26

Billing Workgroup Monthly Billing Workgroup All CA counties may participate Resources for complications Share ideas and tips Workgroup will begin in December. Webinars will begin in June, 2013. “Coming together is a beginning, staying together is progress, and working together is success.” - Henry Ford

Statewide Insurance Contract Results of participating county insurance surveys Discussions with other successful states CA School Health Association partnership Across all 6 counties, “No insurance” is #1 Medi-Cal is #2 Anthem Blue Cross is #1 private insurance

Completed and launched July 1, 2012 CAIR Modifications Completed and launched July 1, 2012

Kern Contracts Billable Contract Aetna Blue Shield Humana Medicare Contracted 8/10 Actively billing Managed Care System Executed 4/25/2012 Actively Billing Blue Shield BOS 12/2011 Awaiting final contract Tri-West Approved March 2012 retroactive to 6/2011 Medicare Kern Board of Supervisors 4/17/12 Checking into revising contract for us Humana Approved 5/1/2012 Awaiting contract and final signatures SISC Submitted 1/2012 Rejected for lack of hospital privileges United Health Care Initial Stages Aetna Awaiting Final signatures Anthem Blue Cross Billable Contract Aetna: Initial Stages, still trying to reach Contract manager to begin process Anthem BC: Approved through a back door. Currently being reviewed by Kern CC, and awaiting signatures. Blue Shield: Credentialing passed 3/27/2012. Contract executed 4/25/2012. Humana: held up in credentialing due to hospital agreement. Trying to get an ancillary contract Medicare: After several applications, it was approved in March/ 2012. Managed Care System (county employee plan): Contracted in 8/2010; actively billing SISC: Approved 5/1/2012 through the Blue Cross contract. Waiting for counsel approval and final signatures. Tri-West; In credentialing phase. Trying to resolve an issue with KMC providers. United Health Care: Rejected because we do not have hospital admitting privileges.

Cigna & Blue Cross Now issuing contracts for immunizations billing only Cigna Contact Donna Dojan (860) 226-5725 Blue Cross Contact Athina Kinsley kinsleya@co.kern.ca.us Include LHD tax identification # LHD name NPI#

Questions? Next Meeting Tuesday, October 30 at 2:00 PM Future topics