© WSU Community Engagement Institute, (316) 978-3843 Improving Immunization Billing in Local Health Departments: The Story of a CDC Immunizations Grant AAron Davis, MBA Project Manager Center for Public Health Initiatives June 9, 2016 [email protected]
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1© WSU Community Engagement Institute, (316) 978-3843
Improving Immunization Billing in Local Health Departments:The Story of a CDC Immunizations Grant
AAron Davis, MBAProject ManagerCenter for Public Health InitiativesJune 9, 2016
2
The story of a CDC Immunizations Grant
• What we did• How we did it• Why we did it• Lastly….what can you gain from it?
3
Agenda
1. Grant Purpose & Background2. Discuss the three projects of the grant3. Goals & Accomplishments4. What we learned5. Guidance moving forward
44
Project Background
Implementation of Strategic Plans for Billing for Immunizations Services in Health Department Clinics
5
Intent of the Grant
• Problem Statement:
– Insured patients are accessing immunization services at public health departments for free or a nominal administrative fee.
• Purpose:
– To enable public health departments to bill health insurance plans, with the intent of capturing maximum immunization service delivery fees.
• Outcomes:
– Short Term: Public Health Departments able to begin/expand/or continue to capture reimbursements for immunization services.
– Long Term: Greater reach of immunization efforts.
6
Background
• 2012 Kansas Immunization Program award for “CDC Immunizations Billing Planning Grant”– Contract with KFMC– Surveys of billing practices across the state– Pilot Project for measuring effects of Certified Coders
7
KFMC Recommendations
1. Biller specific coding manuals2. AAPC Coding Training (will also cover ICD-10)3. Electronic Health Record Pilot Program
8
Background
• 2014 Kansas Immunization Program award for CDC grant: “Implementation of Strategic Plans for Immunization Services in Health Department Clinics”– Contract with Center for Public Health Initiatives of the
Community Engagement Institute at WSU
9
October 2014
1. Billing Manual
2. LHD specific Training
3. PMS/EHR Pilot
4. Continue Survey
1010
Billing & Coding Manual
1111
Billing & Coding Manual
1212
Kansas Local Health Department Clinical Services
Billing & Coding Guide
13
Design Team has included…
• Johnson County HD• Harvey County HD• Harper County HD• Pottawattamie County HD• Riley County HD• Franklin County HD• Ellsworth County HD• Shawnee County HD• Haskell County HD• Reno County HD
14
Clinical Services Coding Guide
Billing Policies & Procedures
• Section 1: Provider Enrollment• Section 2: Insurance Eligibility & Verification• Section 3: Coordination of Benefits• Section 4: Claims Submission & Resubmission• Section 5: KMAP
15
Clinical Services Coding Guide
Methodologies & Common Coding
• Section 6: Immunization Services• Section 7: Child Health Services• Section 8: Women’s Health Services• Section 9: Adult Health / Miscellaneous Services• Section 10: Laboratory Services• Section 11: Appendices
16
Clinical Services Coding Guide
Where to find it?
• http://www.kdheks.gov/olrh/download/KS_Billing_Resource_Manual.pdf
17
Lessons Learned
• Sustainability is everyone's first question• Understanding what the codes mean and how to use
them VS. knowing other departments use them
18
1919
Kansas Local Health Department Specific Coding Training
20
KS LHD Coding Training
World of Medical Coding
What LHDs Code
21
KS LHD Coding Training – June 2, 2015
• First meeting of LHD Billers from Across the state
• Great Discussion• 80+ LHDs represented• Sadly, the training missed
the mark
22
KS LHD Coding Training – Sept 1&2, 2015
• Online webinar• 90+ LHDs represented• Training was better, but
still didn’t answer all the questions we wanted it to
• Videos still available online
23
Lessons Learned
• Why is this so difficult?
• How do we get this right in the future?
24
2525
Practice Management Software & Electronic Health RecordsKansas LHD Pilot Program
26
Quick Definitions
• Electronic Health Records (EHR)• Practice Management Software (PMS)• Billing Software• Hybrid Systems• Outsourced Billing• Clearinghouse
27
Pilot Project Benefits
• Training and guidance from experienced EHR consultants• Technical Assistance from WSU’s CPHI• Financial assistance (75% of a system, up to $10,000) for
PMS/EHR• Peer Learning Workgroup
28
Criteria for Participation
• Must have >40% of total billed revenue from Immunizations Services OR must be the sole immunizer in the county for adults and/or children.
• Must be a Local Health Department that has not signed a contract with an EHR company in the last 2 years.
• Must be able to provide baseline data for application.
29
Selected Counties
• Populations ranged from 2500 to 35000• FTEs range from 2.5 to 15• Annual Billing income from all sources ranges from
$35,000 to $350,000• # of annual unduplicated encounters range from • 900 to 6800
30
Summary of Project
•EHR Review and Implementation Training (Synovim)•Demos of 11 vendors, discussions with more•Presentation from a fellow LHD who had implemented a system
•Weekly calls to discuss issues and questions•Monthly reports to share where departments were in the process
•Surveys, surveys and surveys
31
Timeline of Pilot
32
Timeline of Pilot
33
Tools for Implementation
1. Team Charter2. Department Workflow Tools3. Goals Document4. Implementation Timeline &
Project Plan5. IT Evaluation6. Chart Migration Worksheet7. Data Entry Template
Guidance Document
8. Vendor Demo Script9. Vendor Evaluation Tool10.Staff Computer Knowledge
Evaluation11.Patient Satisfaction Survey12.Post Implementation
Evaluation
34
Review and Evaluation of systems
Reviews and discussion of some kind completed with:
• Nightingale Notes• Patagonia• Insight by Netsmart• Smart Health Claims• Athena Health• Sevocity• HealthPac
• Healthcare First• Mitchell & McCormick• Allscripts• eClinicalWorks• KIPHS• CDP
35
Vendor Differences
• Public Health vs. Private Practice focus• User Interface (friendly to use/navigate)
– Clinical– Financial– Administrative/reporting
• Training and Customer Service• COST!
36
Vendor Selections
• Patagonia Health: 5 • Nightingale Notes by Champ Software: 4• AthenaHealth: 2
37
Implementation
1. Set up data elements, work flow, templates & pathways2. Training on the system3. Testing of the system (practice)4. Adjust data elements, work flow, templates
38
WebIZ connections
• As of today, zero systems are connected• Two are in the beta testing (getting connected)• All should be done by the end of summer
39
Surveys & Results
• Financial Data– 2014 (prior implementation)– 2015 (during implementation)– 2016 (after implementation)
• Staff Transitional Survey– Grant Process– Internal changes
40
Surveys & Results - Financial
2014 2015 2016
Total Encounters 33,214 38,713
Total Billing Rev $1,531,268 $1,558,037
Total Imm Encounters 20,155 23,365
Total Imm Billing Rev $1,121,130 $1,174,506
Results for 9 pilot sites
41
All Billing Revenue Across 2 years
$‐
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
$180,000
$200,000
2014 Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4
Pilot 1 Pilot 2 Pilot 3 Pilot 4 Pilot 5 Pilot 6 Pilot 7 Pilot 8 Pilot 9 Pilot 10 Pilot 11
42
All Billing Revenue Across 2 yrs – 2 pilots
$‐
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
2014 Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4
Pilot 2 Pilot 4 Pilot 5 Pilot 6 Pilot 7 Pilot 8 Pilot 9 Pilot 10 Pilot 11
43
Staff opinions Survey @ 3 months in
• 37 responses from 10 LHDs– 13 Clerical/Administrative– 15 Clinical– 3 Clinical/Administrative– 6 Other
• Whole group Vs each vendor– Only one response from AthenaHealth users
44
Staff Opinions - Pilot
Please indicate your level of agreement with the following statements, "Being part of the CDC EHR pilot helped with:”1. Reviewing EHR options available.
2. Evaluating needs and system requirements.
3. Making a decision on what system to purchase.
4. Contract negotiations.
5. Being comfortable with the price of the system.
6. Creating a forum to discuss issues and questions with other departments.
7. Effectively implementing the new EHR system.
45
Staff opinions (3 months in) All Staff
Please rate your level of agreement with the following statements regarding your use of the new EHR system.1. The EHR has made my job easier compared to our previous systems/processes.
2. The calendar function of the EHR is better than our old calendar system.
3. This EHR clearly displays the information I need without unnecessary information or other clutter.
4. This EHR allows me to complete tasks efficiently, without seemingly unnecessary steps.
5. Learning to use this EHR was easy.
6. Our EHR vendor provides excellent support (for instance, fixing bugs quickly, offering useful training, and providing answers in a timely manner).
7. I enjoy using this EHR. I would recommend our current EHR to my counterparts in other health departments.
46
Staff opinions (3 months in) Admin.
Please indicate your level of agreement with the following statements regarding your use of the new EHR system. 1. Scheduling patients is easier than it was in our previous system.2. Looking up patient information is more efficient.3. Documentation of clinical information is more detailed and
thorough.4. Billing is easier than it used to be compared to our old
system/process.5. Time spent submitting insurance claims has decreased.6. The overall billing process of the department has improved.
47
Staff opinions (3 months in) Clinical
Please indicate your level of agreement with the following statements regarding your use of the new EHR system.1. This EHR helps me see more patients per day than I could with paper
charts. Disagree
2. I can document care easily and efficiently. Neutral to Disagree
3. Documentation of clinical information is more detailed and thorough. Neutral
4. Using the EHR has improved my ability to make decisions about patient care. Disagree
5. This EHR helps me avoid making clinical mistakes. Neutral to Disagree
6. This EHR helps me focus on patient care rather than on the computer. Disagree
48
Staff opinions (3 months in) Comments
• Because we are still learning the EHR it is still hard to measure the progress in understanding other staff role and responsibilities. Communication between staff has increased measurably.
• Many of the steps are cumbersome and documented several times. A lot more time is spent on documentation than the past.
• Took some frustrations to adjust and get it set up properly
49
Cost/Benefit?
Thanks AHIMA!
50
Cost/Benefit?
• Compare your workflows today compared to workflow with the EHR– You have to have clear goals and expectations!
51
Cost/Benefit?Outline Current Costs & Future Goals for:• Increased productivity (chargeable)• Increased productivity (flexible) • Reduce data entry• Increased charge capture & timely filing• Software maintenance & support • Filing, retrieval, and storage of paper charts• Mailing costs• Write-off of bad debt• Denial rates• No Show rates• Reporting and analysis
52
How are things going?
• In the short 15 month period we have seen:– 3 new directors– 4 changes in lead billing staff– I have heard several users say they wish they could
go back to their old system / way of doing things– 11 departments have said they know this will be
great once the kinks get worked out
5353
Grant TargetsDid we meet our goals? What’s next?
54
October 2014
1. Billing Manual
2. LHD specific Training
3. PMS/EHR Pilot
4. Continue Survey
5555
Practice Management Software & Electronic Health Records
Guidance/Toolkit
56
Landscape of Health IT in KS LHDs
• What are people using?• What is Meaningful Use and does it matter?• Some EHR tools are available…but…
57
Meat & Potatoes and my 2 cents…
1. Stark realities you need to accept2. Assessing department capacity & staffing needs3. Features & benefits4. How to select systems5. Costs, timelines & steps
58
Stark Realities you need to accept
59
Stark Realities you need to accept
60
Assessing Capacity
61
Assessing Capacity
62
Staffing Needs (Tech Savvy, leadership, buy-in)
• First, you MUST have a tech-savvy champion• Second, you MUST have a back-up• Third, you MUST get everyone to move forward
together.
63
Features & Benefits
• General Usability• Patient Demographics• Scheduling• Consents & Authorizations • Patient Charting & History• Program specific data
collection• Order Entry and Processing
• Medication Inventory• Quality Improvement• Billing• Reporting• Privacy and Security• Vendor Implementation and
Support• System Connectivity
64
How to select systems
• Selection Criteria Matrix• Do Demos with multiple systems• Don’t purchase a system until you see it live in action
65
Costs
• COSTS VARY! By vendor and with the same vendor.• Caveat – Company, Athena, licenses, training,
discounts, hardware & support, home health and other add-ons.
• Start-up Costs– 3-5 staff ($9000-$11,250) (average of $9,800)– 6-15 staff ($9200-$13,500) (average of $11,200)
• Annual Fees – 3-5 staff ($5,760-15,600) (average of $9,924) – 6-15 staff ($5,040-15,600) (average of $9,444)
66
Timelines & Steps
• Phase 1: Assess Your LHD’s Readiness• Phase 2: Approach Planning• Phase 3: Selecting an EHR• Phase 4: Conduct Training and Adjust System• Phase 5: Implement EHR and Adjust System• Phase 6: Continue Quality Improvement
(adjust how you use it)
67
68© WSU Community Engagement Institute, (316) 978-3843
Improving Immunization Billing in Local Health Departments:The Story of a CDC Immunizations Grant
AAron Davis, MBAProject ManagerCenter for Public Health InitiativesJune 9, 2016
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