Action 13.
Regular Board of Supervisors Meeting
Health & Social Services
- Meeting Date:
- 05/21/2013
- Title:
- The Arizona Partnership for Immunizations
- Submitted By:
- Gussie Motter, Board of Supervisors
- Department:
- Health & Social Services
Presentation:
No A/V Presentation
Recommendation:
Approve
Document Signatures:
BOS Signature Required
# of ORIGINALS
Submitted for Signature:
Submitted for Signature:
2
NAME
of PRESENTER:
of PRESENTER:
Ray Falkenberg
TITLE
of PRESENTER:
of PRESENTER:
Administrative Services Manager
Mandated Function?:
Federal or State Mandate
Source of Mandate
or Basis for Support?:
or Basis for Support?:
Docket Number (If applicable):
Information
Agenda Item Text:
Approve the Billing Services Contract between Cochise Health and Social Services and The Arizona Partnership for Immunizations (TAPI), a non-profit Arizona corporation effective for a one year term with automatic annual renewals.
Background:
CHSS has been diligently working to establish bilateral contracts with numerous private insurance companies so the county can begin to bill for some health services that it provides. To date, we have received BOS approval for two such contracts, with one additional contract pending.
Concurrent with this initiative, CHSS management has been investigating third-party billing services to assist with the billing process. Based on numerous factors, it was decided by health management that the TAPI model best meets the needs of the department.
Salient features of the TAPI model include the following:
• Ease of implementation. TAPI provides an on-line eligibility confirmation system (including training), that is similar to the tool we currently use to determine AHCCCS eligibility. The TAPI tool includes information for all contracted private and public insurance plans (including AHCCCS), so only one on-line eligibility tool will be needed. Conversely, if Cochise County were to develop an in-house billing system, eligibility verification would need to be undertaken separately for each insurance plan.
Claim filing will consist of transmitting to TAPI a copy of our patient encounter form, which form is already completed for all patients regardless of insurance coverage. Hence, additional paperwork is avoided.
• TAPI already maintains contracts with the top private insurers in the state, covering approximately 90% of privately insured children in Arizona. Cochise County can immediately benefit from TAPI’s contracts rather than continuing its own contracting/ credentialing process with each insurance company.
• No vaccine payment to TAPI unless the county’s vaccine costs are 100% covered. CHSS receives payment for up to 100% of a vaccine’s cost before TAPI is compensated for the vaccine. Once vaccine reimbursement reaches 100% of the county’s actual cost, TAPI receives 40% of the incremental amount. Additionally, TAPI receives 40% of the administration fee. This claims-sharing formula represents the total cost to the county.
Based on the volume of potential private insurance vaccines administered in calendar year 2012, CHSS would have generated nearly $6,000 in net incremental revenue. TAPI’s total compensation would have been $954, or 14% of total reimbursement, illustrated as follows:
Total Reimbursement $6,771 100%
TAPI Share $ 954 14%
CHSS Share $5,817 86%
This is considered to be a very good value for the county. For the $954 in potential foregone revenue in this example, the county will receive the following services:
• Ability to collect under all of TAPI’s master insurance company contracts.
• Full access to TAPI’s on-line eligibility site.
• Training in all aspects of the process.
• All billing labor – the only steps county employees need to take are (i) confirm patient eligibility and (ii) transmit the patient encounter form to TAPI. TAPI performs all other billing and collection functions, and remits a net check to the county.
• Cochise County can transition to an in-house system at any time. TAPI is a non-profit entity with the primary mission to increase childhood vaccination rates in Arizona. If Cochise County determines over time (based on the information gained during our initial experience with TAPI) that it would be advantageous to take billing in-house, TAPI will gladly advise and assist in the transition.
Members of TAPI include the Arizona Department of Health Services; AHCCCS; various county health departments, community health centers, and fire departments; and various private corporations, foundations, professional organizations, and children’s advocacy groups.
Through the joint efforts of TAPI’s 400 public and private partners, immunization coverage rates in Arizona have improved dramatically, with nearly three in four children fully immunized by age two (up from only 43% in 1993).
Currently nine AZ counties (Maricopa, Pima, La Paz, Apache, Mojave, Gila, Graham, Navajo, and Yuma) use TAPI to bill for children’s vaccines. Health directors at these counties report favorable outcomes with the TAPI model.
Radi Ann Porter (Director of Nursing) is satisfied with the Contract from an operational perspective, and Terry Bannon is satisfied from a legal standpoint. The Contract may be terminated at any time by either party with sixty days’ written notice.
Concurrent with this initiative, CHSS management has been investigating third-party billing services to assist with the billing process. Based on numerous factors, it was decided by health management that the TAPI model best meets the needs of the department.
Salient features of the TAPI model include the following:
• Ease of implementation. TAPI provides an on-line eligibility confirmation system (including training), that is similar to the tool we currently use to determine AHCCCS eligibility. The TAPI tool includes information for all contracted private and public insurance plans (including AHCCCS), so only one on-line eligibility tool will be needed. Conversely, if Cochise County were to develop an in-house billing system, eligibility verification would need to be undertaken separately for each insurance plan.
Claim filing will consist of transmitting to TAPI a copy of our patient encounter form, which form is already completed for all patients regardless of insurance coverage. Hence, additional paperwork is avoided.
• TAPI already maintains contracts with the top private insurers in the state, covering approximately 90% of privately insured children in Arizona. Cochise County can immediately benefit from TAPI’s contracts rather than continuing its own contracting/ credentialing process with each insurance company.
• No vaccine payment to TAPI unless the county’s vaccine costs are 100% covered. CHSS receives payment for up to 100% of a vaccine’s cost before TAPI is compensated for the vaccine. Once vaccine reimbursement reaches 100% of the county’s actual cost, TAPI receives 40% of the incremental amount. Additionally, TAPI receives 40% of the administration fee. This claims-sharing formula represents the total cost to the county.
Based on the volume of potential private insurance vaccines administered in calendar year 2012, CHSS would have generated nearly $6,000 in net incremental revenue. TAPI’s total compensation would have been $954, or 14% of total reimbursement, illustrated as follows:
Total Reimbursement $6,771 100%
TAPI Share $ 954 14%
CHSS Share $5,817 86%
This is considered to be a very good value for the county. For the $954 in potential foregone revenue in this example, the county will receive the following services:
• Ability to collect under all of TAPI’s master insurance company contracts.
• Full access to TAPI’s on-line eligibility site.
• Training in all aspects of the process.
• All billing labor – the only steps county employees need to take are (i) confirm patient eligibility and (ii) transmit the patient encounter form to TAPI. TAPI performs all other billing and collection functions, and remits a net check to the county.
• Cochise County can transition to an in-house system at any time. TAPI is a non-profit entity with the primary mission to increase childhood vaccination rates in Arizona. If Cochise County determines over time (based on the information gained during our initial experience with TAPI) that it would be advantageous to take billing in-house, TAPI will gladly advise and assist in the transition.
Members of TAPI include the Arizona Department of Health Services; AHCCCS; various county health departments, community health centers, and fire departments; and various private corporations, foundations, professional organizations, and children’s advocacy groups.
Through the joint efforts of TAPI’s 400 public and private partners, immunization coverage rates in Arizona have improved dramatically, with nearly three in four children fully immunized by age two (up from only 43% in 1993).
Currently nine AZ counties (Maricopa, Pima, La Paz, Apache, Mojave, Gila, Graham, Navajo, and Yuma) use TAPI to bill for children’s vaccines. Health directors at these counties report favorable outcomes with the TAPI model.
Radi Ann Porter (Director of Nursing) is satisfied with the Contract from an operational perspective, and Terry Bannon is satisfied from a legal standpoint. The Contract may be terminated at any time by either party with sixty days’ written notice.
Department's Next Steps (if approved):
The Department respectfully asks for approval
Impact of NOT Approving/Alternatives:
It will take considerably longer to establish a reliable internal billing system, including finalizing contracts with numerous other private insurance companies, identifying and allocating internal staff resources, and training front-office staff on numerous individual company eligibility systems. Importantly, implementing TAPI’s system does not preclude Cochise County from eventually establishing an in-house system. In fact, the information and experience obtained from initially teaming with TAPI would be instrumental in setting up such a system, a process with which TAPI is willing to assist.
To BOS Staff: Document Disposition/Follow-Up:
Does not require Board signature.
Fiscal Impact
- Fiscal Year:
- One-time Fixed Costs? ($$$):
- Ongoing Costs? ($$$):
- County Match Required? ($$$):
- A-87 Overhead Amt? (Co. Cost Allocation $$$):
- Source of Funding?:
Fiscal Impact & Funding Sources (if known):
The cost model described above is considered very reasonable in light of the value of services received. Cochise County will benefit by commencing on July 1, 2013 the turn-key billing of private health insurers for vaccination services provided. This is much sooner than the county could set up a comprehensive in-house eligibility and billing system.