1. CA Public Health Billing Project
Billing Workgroup
September 25, 2012

2. 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.

3. 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

4. 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.

5. 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

6. 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

7. 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.

8. 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.

9. 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.

10. 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

11. 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

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

13. Training Team Athina Kinsley Timi Granados On the road, again!
Health Insurance Specialist
(661)
Timi Granados
Administrative Coordinator
(661)
On the road, again!

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

15. 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

16. 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

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

18. 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.

19. Cigna & Blue Cross
Now issuing contracts for immunizations billing only
Cigna
Contact Donna Dojan (860)
Blue Cross
Contact Athina Kinsley
Include LHD tax identification #
LHD name
NPI#

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