Billing for Immunizations. Jeannine Carney Insurance Billing Manager Albany County Department of Health

Transcription

1 Billing for Immunizations Jeannine Carney Insurance Billing Manager Albany County Department of Health

2 Objectives Determine Population served Develop a Billing Strategy Educate Staff on Process Implement Process

3 Breaking Down the Billing Process The Billing Process The Billing Process involves Clinic and Fiscal Employees working together What governs your billing VFC rate Provider Manuals Insurance Policy insurance portals by company Tools needed to reach the revenue producing goal

4 Target Population Determine what immunizations are given Estimate target population served by your county Children With insurance coverage Is the coverage Medicaid or Commercial Insurance Without insurance coverage Adult Is the coverage Medicaid or Commercial Insurance Estimate % of Commercial Insurance Company Coverage

5 Development of Fee Schedules and Billing Forms Determine Cost of Vaccine Review Reimbursement rate for vaccine from contracted Commercial Insurance Provider Don t forget the Administration Fee Use Fee Schedule information to make a user friendly check off form for billing

6

7 Develop a Billing Plan for Your Population Should I contract with Commercial Insurance Companies? Develop a Prior Authorization Process Bill Medicaid Fee for Service and Medicaid Managed Care Plans and Medicare Charge Out of Pocket Fees to Commercial Plan Holders

8 Determining the Insurance Companies to pursue contracts Review your patient data, and determine the insurance companies who provide coverage for your patients New Jersey Medicaid provider enrollment Amerigroup Medicaid Managed Care Group Horizon NJ Health Medicaid Managed Care Group United Healthcare Community Plan Medicaid Managed Care Group

9 Tools needed for Claim Submission Medicaid Electronic Billing information CMS 1500 form for Commercial Insurance Companies Fill N Print program Know Timely Claim Filing Requirements example 60 days Develop Excel spreadsheets for tracking payments

10 Information needed for Contracting or Credentialing Fee Schedules with CPT Codes for Billing Helpful CPT Code Website: _Coding_Table.pdf Malpractice Certificates of Insurance for Physician(s) providing service Tax exempt letter for county State License to practice for Physician(s) National Provider Number (NPI) for Physician(s)

11 Key to success with Contracting Communication with the Contract Representative from the Insurance Company Phone number or Ask for Help Follow up with questions Review Insurance Company s online site Invite Representative to clinic site Provide requested information in a timely manner

12 What to look for in a Practice Management System Can the system process UB 04 and CMS 1500 forms? Cost of claim processing Does the Appointment Book information interface with Billing? Cpt Code and Diagnosis Code check prior to processing Rejected Claims are listed when claims are billed

13 Example of a Billing System Patient insurance information is entered when appointment is made Insurance eligibility is checked and coverage for service approved Communicate with patient status of coverage Scan insurance card into practice management, or collect payment for services Check off services on Billing Sheet

14 Example of a Billing System Continued Clinic Staff brings Billing Sheet to Billing Staff Services entered into Practice Management System Explanation of Benefits (EOB) are received from insurance company Post Payments Rebill denied claims Timely Filing Claims Aging

15 In Conclusion Health Department Clinics provide a valuable service and revenue is needed to offset the expenses of the clinics. Revenue from Insurance Companies can be obtained once a system is put in place The Billing System should meet the needs of your clinic.