Submitted on Wed, 2014-04-16
By Nar Ramkissoon, MPH

How four local health departments met funding challenges with creative billing programs for services they already provide.

Medical Billing Success Stories

What could your local health department do with the extra funding created by a new or improved billing program?

  • Would you add back health services that were cut?
  • Would you increase prevention programs in your community?
  • Would you expand your staff and hire back great employees that were let go?
  • Would you upgrade outdated equipment?

The CDC has a number of inspiring stories about local health departments creating sustainable revenue and growing their staff and services.

Sustainable Revenue Can Add Staff Members

Within the first six months of implementing a billing program, a county health department in California had seen its revenue grow by a factor of ten. Lucky for them too, as county budget cuts enacted a few months into their billing program would have forced the department to scale back its services or even shut its doors had the program not been in place. The biggest hurdle in starting the billing program was contracting with insurance companies. According to a department official:

"It was important to have the right person for the job. You need an effective sales rep who is outgoing and not afraid to cold call insurance companies and sell them on public health services."

Once the reimbursements started rolling in, the department hired an insurance specialist full time to identify coding errors and missed opportunities to bill. With the specialist in place, billing became much more efficient and there were less rejections. The extra revenue from billing enabled the department to expand staff.

In Arizona, a billing program started by a group of health departments has also produced great results. Focusing on getting reimbursed for immunizations, the departments were able to infuse $2.5 million of new revenue into their operations. This allowed for expanding services, being able to hire two new nurses, and a childcare consultant to educate teachers on the importance of immunizations.

Sustainable Revenue Can Aid Other Local Health Departments

It takes a special breed of person to put the health of others above your own, but that’s public health workers in a nutshell. They not only want to improve the health of their communities, but of the entire country; so it’s no surprise that when local health departments do start bringing in sustainable revenue that they use it to help other departments.

Back to the billing program we mentioned in California. The new revenue sources brought in by the billing program and insurance specialist not only helped to add employees but was used to train neighboring local health departments to make their own sustainable revenue. The county even made a billing toolkit that has been distributed to local health departments around the country.

Another way that health departments are finding sustainable revenue, is by banding together. It not only helps with idea/skill exchange, it is also a great way to aid in generating more revenue from reimbursements. Forming a coalition with other departments in your area will make insurance companies more willing to work with you. By grouping together, you’re able to make the process easier for insurance companies and provide them with more monetary incentive to approve your department. Banding together also makes it easier to get legislation passed to require insurance companies to recognize public health, as the department mentioned in Arizona did. This makes the often daunting process of credentialing and contracting much easier.

Sustainable Revenue Can Expand Immunization Programs

Local health departments in the state of Georgia banded together to start a billing program of their own.  The program aims to bill private insurance for immunization services. One of the main focuses of the billing program in Georgia is an emphasis on accurate medical coding. Taking a little extra time to ensure claims are 100% correct can help you get reimbursed quicker and at the maximum rates. The first 4 years of the program generated more than $6.5 million in revenue for the departments.

With the new revenue, the local health department was able to privately purchase vaccines to add to their inventory. Uninsured and underinsured citizens in Georgia were able to gain access to even more preventative healthcare measures.

In Massachusetts, local health departments started a billing program with the intention to build relationships with insurers for their immunization services. The program started only with flu shots but has expanded to include all vaccines recommended for adults. The program worked so well that the insurance companies are now partnering with local health departments to spread adult vaccination awareness.

Billing programs can help save health departments on the brink of disaster. It’s amazing just how much of a difference you can make by billing for existing services.  Stop worrying about lost funding and focus on where to spend your new revenue by starting or improving a billing program today. If you would like to learn more about how our claims management experts can help your public health department generate sustainable revenue from existing services schedule a meeting today.

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