Smart Health Claims Revenue Generation for Public Health Sustainability

Illinois Public Health Association Joins Forces With Smart Health Claims

Challenge:

With funding for public health nationwide dropping by billions year after year, health care staff and service cuts have become all too common. The consequences can be dire: increased risk to the health of lower income adults and their children; decreased immunization rates; greater risk of outbreaks from infections and vaccine-preventable diseases; diminished capability to respond to public health needs and threats.

Solution:

Bolstered by funding from the Illinois Department of Public Health, the Illinois Public Health Association (IPHA), one of the largest affiliates of the American Public Health Association, and a leader in the field of public health advocacy, health education and promotion for Local Health Departments (LHD), partnered with the SMART Health Claims team to provide revenue cycle management solutions to its LHD members throughout the state.

Beginning with contract and credentialing services, the SMART Health Claims team worked with individual LHDs to identify their major insurance company payers based on aggregate factors such as plan membership and encounter volume. Subsequently, our knowledgeable and experienced medical billing specialists assisted each participating LHD in securing private insurance contracts with their department’s most prevalent insurance plans at a special membership rate.

At the IPHA’s invitation, the SMART Health Claims team additionally presented a series of training seminars focused on revenue cycle generation through public health billing to the organization’s LHD members. Attendees from throughout Illinois represented a cross-section of public health in the Land of Lincoln, including front desk staff, public health nurses, billing specialists, health officers and administrators.

These training sessions were designed to advise Local Health Departments on the changes to the health care landscape driven by the Patient Protection and Affordable Care Act (ACA), and to educate attendees as to how to capitalize on the new opportunities to generate sustainable revenue for public health. This included SMART Health Claims’ introduction of a step-by-step guide for generating revenue through a public health billing program.

Not surprisingly the first step is to conduct an assessment of the program’s aggregate data and secure beneficial contracts with the major payers. Done and done. As part of the contracts and credentialing presentation, the team shared insights based on their extensive working relationships working with private insurance companies on how to approach payers about securing new or better contracts. Attendees also learned about the most likely obstacles in contracts and credentialing and how to overcome them.

Another key step is adopting billing best practices and optimizing clinical workflow to determine and implement LHD- or facility-specific process activities designed to achieve maximum efficiency, streamline patient data flow and the most effective billing. This is driven by process review and data analysis, from patient registration procedures to posting requirements, with an eye toward maximizing revenues without straining staff resources.

The SMART Health Claims team concluded the seminars with a live demonstration of our secure and health care industry compliant Web-based SMART Health Claims system. Attendees were able to see firsthand how the latest technology can be used to maximize productivity across an entire clinic, reducing overall costs in time and money, thereby increasing the bottom line. Decision-makers also learned key considerations and questions to ask when evaluating a claims management system.

Results:

Working with individual Local Health Departments to secure private insurance company contracts has allowed participating departments to increase sustainable revenue, enabling them to not only continue but even expand the essential services they provide their communities. The proven value of the SMART Health Claims contracting and credentialing initiative also helped grow the membership of the Illinois Public Health Association, allowing the venerable organization to further increase its reach and utility.

With the launch of a billing pilot program, implementations of the SMART Health Claims solution for participating LHDs, now comprising dozens of departments and more than 500 system users, has additionally enabled public entities statewide to automatically verify patient coverage eligibility for private and public payers (like Medicare and Medicaid), efficiently process claims, and secure maximum possible reimbursement to achieve greater financial independence, helping insulate them against shrinking budgets.