Billing at the Milwaukee Health Department Clinics:

An Analysis of Potential Revenue Gains

Presented by: Jamie Aulik Victoria Deitch

Emily Pope Eric Thomasgard

La Follette School of Public AffairsMay 5, 2006

Project Introduction

Budget and Management Division, Department of Administration asked the

La Follette School to analyze billing practices at the Milwaukee Health Department Clinics

Over the past four months we have visited the clinics, interviewed MHD staff, analyzed MHD data, and interviewed officials at other health departments

Milwaukee Health Department Clinics

The MHD operates six clinics for the provision of health services to the uninsured and underinsured

In our analysis we investigated four clinics: Walk-In, Family Health, Tuberculosis (TB) Control and Refugee Health, and HIV/AIDS and STD

These clinics are located at three health centers: Keenan, Northwest and Southside

Services and Billing

These clinics offer a variety of services including immunizations, pregnancy testing, prenatal care, health checks, TB testing and therapy, and HIV/AIDS and STD testing and treatment

Currently, the MHD bills for services provided to Medicaid clients

Services provided to clients without Medicaid insurance are free of charge

Current Billing The MHD has MOUs with three Medicaid

HMOs which allows them to bill for a limited set of services

In 2005, we estimate that the MHD billed Medicaid $31,700 for immunizations, pregnancy tests and health checks

2005 Billing Estimates

Source: Calculations based on data from City of Milwaukee Health Departments’ clinic’ flow sheets, Analysis of Services, Immunization Consent Analysis, billing summary, and Wisconsin Department of Health and Family Services

Medicaid maximum fee rates.

Services

2005 Estimated

Annual Revenue

100% Medicaid Billing for

2005

LossPercent

Lost

Immunizations 29,900$ 52,700$ 22,800$ 43%Health Check Exams 1,400 2,000 600 30%Pregnancy Tests 400 1,400 1,000 71%TOTAL 31,700$ 56,100$ 24,400$ 43%

Potential Sources of Revenue Loss

Clients do not accurately report Medicaid status because they are unaware or are confused by the intake form

Problems at the clinics, MHD main office, or Medicaid HMOs

Medicaid plan does not cover clinic services

Sources of Current Revenue Losses

Self-Report and Are Billed

Self-Report and Are Not

Billed

Do Not Self-Report and

Are Not Billed

Source: Calculations based on MHD Immunization Consent Analysis and Our Medicaid Revenue Estimates

Policy Evaluation Criteria

Maintain level of service to uninsured and underinsured

Increase clinic revenueImplementation feasibility

Policy Alternatives

1. Changes to the billing process

2. Increase billing for services by implementing monthly audits

3. Increase billing for services by implementing incentives

4. Expand existing MOUs to cover additional services

5. Investigate MOUs with private insurance providers

6. Charge uninsured and privately insured a flat fee

Alternative 1: Changes to the Billing Process

Use billing checklistRefer all uninsured clients to

Medical Assistance Outreach Program (MAOP)

Change intake form from “Medical Assistance” to “Medicaid” and “Medicare”

Evaluation of Alternative 1

Maintain Level of Service to Target Population: High

Increase Revenue: High

Feasibility: Medium

Alternative 2: Increase Billing Through Monthly Audits

All billing forms and checklists sent to MHD main office

Create new clinic flow sheetsCompare billing forms to total number

of services provided

Evaluation of Alternative 2

Maintain Level of Service to Target Population: High

Increase Revenue: High

Feasibility: Medium

Alternative 3: Increase Billing By Implementing Incentives

MHD does not currently receive any benefit from billing

We propose that some portion of clinic revenues be returned to the clinics

Must be approved by Milwaukee Common Council

Marion County (Indianapolis) and King County (Seattle) receive 100 percent of reimbursements for services

Evaluation of Alternative 3

Maintain Level of Service to Target Population: High

Increase Revenue: Medium

Feasibility: Medium

Alternative 4: Expand Existing MOUs to Cover Additional

Services Current MOUs permit the MHD to bill Medicaid

HMOs only for certain services We propose that the MHD expand these MOUs

to include STD testing and treatment provided at the Keenan Health Center

STD testing and treatment will continue to be offered anonymously at the Southside STD clinic

HIV/AIDS testing at the Keenan clinic will not be billed

Alternative 4: Revenue Estimates

If the MHD began billing for STD testing and treatment, it could significantly increase revenues

11% 14%

Medicaid at KHC HIV/AIDS and STD 88,800$ 113,100$ Testing 600 800 Hepatitis A and B Immunizations 6,000 7,700 Treatment 95,400$ 121,600$

Alternative 5: Sign MOUs with Private Insurance Providers

MHD does not bill private insurance providers 13 percent of clinic clients have private

insurance MHD could increase its revenue by billing

private insurance Currently, Columbus has a contract with one

private insurance company King County (Seattle) bills private insurance

company without a contract

Alternative 5: Revenue Estimates

Predicted Revenue

Immunizations 19,900$ Health Check Exams 700 Pregnancy Tests 400

21,000$ TOTAL

Private Insurance

Alternative 6: Charge a Flat Fee

If a client does not have Medicaid insurance, clinic services are provided free of charge

Health departments in other cities charge uninsured and privately insured clients

These fees are either fixed or based on a sliding scale

If the MHD imposed a $5 flat fee for services, revenue would increase between $20,300 and $37,300

Evaluation of Alternative 6

Maintain Level of Service to Target Population: Low

Increase Revenue: High

Feasibility: Medium

Recommendations

Based on our analysis, we recommend: Changes to the billing process Increase billing for services by implementing

monthly audits Expand existing MOUs to cover additional

services Investigate MOUs with private insurance

providers