2011 Model Practice Application (Public)

Billing Opportunities Process

Lake County Health Department

Billing Opportunities Process

The team identified an area that could potentially produce revenue that may have otherwise been missed. This supports the practice of efficient and effective utilization of taxpayer monies for governmental operations in public health.

This team has really embraced increasing revenue, accountability and ensuring all billable services are billed out to the correct billing party. Not only does this team bring in additional revenue by finding missed billing opportunities but it identifies missconceptions or trends in billing errors ensuring they are resolved quickly. The team improved interal operations by monitoring trends in billing opportunities to determine internal deficiencies and misconceptions. When deficiencies are identified the Billing Opportunities Team works with clinical staff and accounts recievable staff to increase efficiencies and develop cheatsheets for billing efficiencies.

This two member team has created and implemented a process to research and review all services provided to ensure the billing process is completed accurately. The team is committed to ensuring that there are methods in place to ensure that clients with retroactive insurance have services billed to the correct billing party. This has resulted in an increase of $101,857 in revenue by billing insurance companies for services. Several other county health departments have contacted the team for information regarding the reports used to review services and the process involved. A few other county health departments have implemented the same type of process which resulted in the same outcome of increased revenues.

Objective: To develop a process to research and review all services provided to ensure the billing process is completed accurately. Measures and Data: The measures for the objective include the number and types of all services and comparing that information to identify possible payor sources. The process uses data from Crystal Reports to identify the services, Florida Medicaid Management Information System to research possible payor sources and Excel to track identified problems other than retroactive Medicaid. Results and Feedback: The revenue generated during the reporting period based on billing opportunities is $101,857, the cost of the team member(s) to research billing opportunities based on hourly cost is $17,124.00. The added value is $84,733 for Lake County Health Department. $ 101,857 Value of performance in 2009-10 $ 17,124 Development/production/implementation costs for employees $ 84,733 Added value resulting from improvement. The impact of the team has impacted the citizens of Lake County Health Department by increasing revenues to clinical programs which in turn provides extra funding to programs to provide services to the clients of Lake County Health Department.