Local Health Department Billing

The IPHA Immunization Billing Project is an initiative that was funded by the Centers for Disease Control and Prevention (CDC) to enable local health departments to bill third-party payers for immunization services provided to insured patients. Since 2009, the CDC has given more than $34 million to 38 project awardees to assist them in developing plans that will enable them to begin billing for immunization services (for more information about the CDC Immunization Billables Project, please see: https://www.cdc.gov/vaccines/programs/billables-project/index.html). IPHA implemented the Immunization Billing Project from a grant provided by CDC through the Illinois Department of Public Health (IDPH).

 

Goals of the Project

  • Provide training and technical assistance to LHDs for billing third-party payers.
  • Increase the number of Local Health Departments contracting with third-party payers.
  • Assist Local Health Departments (LHDs) in the credentialing and contracting process.
  • Assist with improving collections on claims submitted.
  • Assist LHDs with entering information regarding their private vaccine stock into IDPH’s I-CARE inventory system.
  • Expand the IPHA vaccine consortium.
  • Develop white papers on best practices in immunization billing.
  • Improve immunization coverage levels.

 

 

Immunization Billing Capacity Building Pilot Project

In Illinois, the pilot phase of the project began in 2012 with a statewide survey regarding billing practices. The goal of the survey was to identify potential pilot sites that had the potential to bill for immunization services and were willing to participate in the project.  The project team chose the following ten LHDs to serve as the pilots:

 

Adams           Sangamon

Bureau           Southern Seven

Jackson          Stephenson

Kane              Wabash

McLean           Whiteside

 

These LHDs represented a mix of urban and rural health departments of various jurisdictional size and geographic location. The goal of the pilot grant was to build the capacity of LHDs to bill third-party payers for immunization services, and to determine the feasibility of expanding immunization billing to other LHDs.  During the pilot project, the ten pilot sites generated more than $900,000.00 in combined revenue from immunization billing.  The pilot project played an instrumental role in laying the foundation for expansion of third-party billing capacity across the state.

 

 

Illinois Immunization Billing Implementation Grant

At the conclusion of the pilot project, the initial data confirmed the potential to generate significant revenue through third-party billing. Therefore, IPHA again partnered with the CDC and IDPH to roll out implementation of third-party billing statewide. This grant commenced in September of 2014.

The main goal of the two-year (2014-2016) Immunization Billing Implementation Project was to increase the number of local health departments (LHDs) in Illinois that are billing for immunizations and other preventive health services.

 

A key aspect of the implementation project was the introduction of an optional Electronic Health Records system (EHR) that was designed specifically for public health departments. CDP Inc., of Romeoville, Illinois was selected as the project’s consultant for third-party billing services and technology.  CDP provides billing support for the public healthcare system including: appointment scheduling, practice management applications, third-party billing services, and revenue cycle management. A value-added component of CDP’s suites is the option to integrate ezEMRx, an EHR system that was customized to meet the unique needs of LHDs. For more information about CDP and ezEMRx, please see: https://www.cdpehs.com/Solutions/EHR

 

 

IPHA Billing Capacity Survey Results – March 2016

In early 2016, a statewide comprehensive billing capacity survey determined that through IPHA’s capacity-building work on this project at least 84 Illinois LHDs are now billing for at least one immunization-related or preventive health service—far exceeding the grant goal of 70 LHDs.

  • 85 health departments represented in survey results
  • 84 health departments report billing for some type of service.
    • 73 billing Medicare
    • 80 billing Medicaid
    • 66 billing private insurance
      • ~40 private insurance companies being billed
    • 30 of the health departments in Illinois are contracted with CDP and using ezEMRx.
    • Several health departments are contracted with UPP or other billing providers.
    • A small number of health departments are performing their own billing in-house.
  • 68 health departments report providing adult immunizations
  • 70 health departments report providing child immunizations

 

Revenue Generation

The ten LHDs that participated in the pilot Immunization Billing Project for IPHA in 2012-2014 estimated that their combined revenue earned by billing third-party payers for immunization services would be $420,000.  At the end of the pilot project, these LHDs had actually earned $911,000 from billing third-party payers – an increase of 116 percent from projected revenues. 

As of December 2016 and the end of the implementation project, the 30 LHDs in Illinois that are billing third-party payers for immunizations and other preventive health services through CDP and ezEMRx have earned just over $3 million in revenue!

 

Vaccine Consortium

Over the course of the project, IPHA had a goal to increase to 50 the number of LHDs in Illinois that were purchasing vaccines and other preventive services supplies through a vaccine purchasing consortium.  IPHA developed two vaccine purchasing consortiums, one for influenza vaccines via FFF Enterprises and one for other vaccines and healthcare supplies through Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP).  As of December 2016, more than 70 LHDs in Illinois are purchasing supplies through these two vaccine purchasing consortiums.

  

Training Sessions and/or Webinars

 

Over the course of the project, IPHA was asked to convene 8 billing-related training programs.  As of December 2016, IPHA has convened a minimum of 12 training programs:

 Meaningful Use for Public Health Departments

 ICD-10 Training

 Community Immunization Education Toolkit

 IPHA Flu Purchasing Consortium

 Impact of HIPAA on Public Health—Now

 MMCAP Overview

 Blue Cross Blue Shield PPO Network Changes

 Billing for Public Health

ezEMRx Billing Reporting Training

    • June 8 2016
    • For CDP Users

ezEMRx Billing and Coding Training

    • June 23, 2016
    • For CDP Users

 Flu Vaccine Marketing

 Billing Medicaid – What do you need to know?

 

 

White Papers

 

Over the course of the project, IPHA was asked to develop 8 best practice white papers on billing-related topics.  IPHA has developed and disseminated the following 8 billing best practice white papers:

 

Impact of HIPAA on Public Health—Now

Gearing Up for Meaningful Use—A Public Health Perspective

Immunization Credentialing and Contracting for Public Health Departments

Immunization Billing for Public Health

Common Medical Billing Mistakes and Solutions: A Local Health Department Perspective

Medical Billing Audits for LHDs

 Human and Economic Burden of Four Major Adult Vaccine-Preventable Diseases (VPD) in Illinois

Community Outreach Programs and Medical Billing:  Helping Local Health Departments Generate Revenue and Sustain Vital Services

 

As a final significant training program for the project, Professor Shefali Mookencherry of Benedictine University is developing a series of 16 online training modules that will comprise an online third-party billing course designed exclusively for public health professionals.  This course will be archived on the IPHA and University of Illinois at Chicago’s Public Health Learning website websites in early 2017.

 

Stakeholder Advisory Group

Over the course of the project, IPHA was asked to convene a Stakeholder Advisory Group (SAG) that would provide guidance to the project and help trouble-shoot challenges with third-party billing.  This group was to hold quarterly meetings and was to be comprised of IPHA and IDPH staff, health plan representatives, vaccine manufacturers, LHDs, public health clinics and professionals, and staff from the Department of Insurance and the Department of Healthcare and Family Services.


CDC Success Story

 

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