Archive for Wednesday, August 7, 2013

Lawrence-Douglas County health department unable to bill Medicare

August 7, 2013


The Lawrence-Douglas County Health Department is currently unable to bill Medicare for health care services it provides to seniors who go there for immunizations and other services, a problem that is currently costing the agency thousands of dollars a year in reimbursements.

But agency officials say they expect the problem to be resolved soon, at which point the department can resubmit claims that have been pending for a year or more.

“As for Medicare, our account was not revalidated sometime in 2012 due to a personnel issue and so the director of administrative services is in the process of getting the Health Department revalidated,” Karrey Britt, the department's spokeswoman, said in an email this week.

According to Britt, the federal Centers for Medicare and Medicaid Services, or CMS, issued rules in 2011 requiring certain providers, including the local health department, to “revalidate” their accounts so they could continue submitting claims for Medicare, the federal health insurance program for seniors.

Britt would not comment on why the health department did not get revalidated, except to say that the paperwork was not submitted on time. Officials at the regional office of CMS in Kansas City, Mo., did not respond to requests for information.

Dan Partridge, executive director of the agency, said the problem is being addressed and he expects it to be resolved soon.

“When we became aware of it, we got that turned around ASAP,” Partridge said.

He noted that there are about $6,000 worth of claims filed with Medicare that are pending and should be paid once the agency is revalidated.

Direct medical services to patients is only a small part of the local health department's overall operations. Most of those services involve immunizations, family planning and testing for sexually transmitted diseases.

“The biggest drivers are family planning and immunizations,” Partridge said.

Most of the agency's operations involve inspections of child care and other facilities, monitoring outbreaks of infectious diseases, and providing health-related education to the community on topics such as breast feeding.

It also operates Project LIVELY, a program that helps seniors and people with disabilities connect with services that enable them to remain independent and stay in their own homes.

According to the department's most recent annual report, the clinic sees about 80 patients per day for health care services as well as nutrition education and referrals to other services.

Britt said about 48 percent of the patients seen in the clinic have some kind of health coverage – Medicare, Medicaid or private insurance. The other 52 percent, she said, are uninsured.

During 2012, Britt said, the department billed out $373,986 for medical services and received $231,344 in payments, or 62 percent of what it billed.


bearded_gnome 4 years, 7 months ago

Direct medical services to patients is only a small part of the local health department's overall operations. Most of those services involve immunizations, family planning and testing for sexually transmitted diseases.

“The biggest drivers are family planning and immunizations,” Partridge said.

---family planning, STD treatment, and immunizations. are these also the primary costs for the senior population that'sthe focus of this article? it's a little vague.

clearly the obama administration doesn'tknow what it's doing RE health. lookout for the full inception of obamacare! obamacare did take money from medicare and gave it to obamacare.

jafs 4 years, 7 months ago

Thanks - good link.

I wonder if the planned reductions in payments to providers will affect how many providers take Medicare patients - their reimbursement rates are already pretty low.

Alceste 4 years, 7 months ago

The only "excuse" for this gross oversight can be very poor management/supervision. Too much "laid backness" going on at the "health department" and there always has's a "cruise job" with little emphasis on oversight. The article itself demonstrates the failure of the department's "leadership" to own the error......they're good at making excuses and making an effort to take the spotlight off of the error....but in the end it's the elderly and disabled who suffer (disability recipients of Medicare) and there's really no excuse the paper work wasn't filled out in a timely fashion.

Alceste is curious if the person or persons responsible for not doing their job will be disciplined for this gross error.?

Dan Eyler 4 years, 7 months ago

Your right. They haven't billed Medicare for nearly two years. The director and managers have been aware the whole time. There has been no cuts to medicare that affects the health department. They provide two things that medicare pays for. Pneumonia and flu shots. Thats it. Those services haven't been cut. Smoke and mirrors. They lost thousand by not billing Blue Cross for patients with insurance. Read the minutes of their board meetings starting in late 2010 early 2011. Clear as day there was serious mismanagement issues but no effort to address it even when it was identified by the board of directors. They have lost so much money they could have collected and put back into the department but instead the County and City Commissions who are clueless just pumps more tax dollars to the director. This is only a sliver of how poorly the place is managed. There were also warnings sent out to all Ks healthcare departments across the state from Topeka after a review was done warning them to stop worrying about writing for grants and start assuring your billing, coding and collecting process is working. This health department was spending their time writing for grant money to support their "academic agenda" and had no control of there billing. The director has no clew to the clinical operations and that is where all the losses are coming from. He needs to go.

Kathleen Ammel 4 years, 7 months ago

All a provider had to do to be "revalidated" was get an account & log on to PECOS (Provider enrollment, chain, and ownership system) website. Yes, it was a pain but not that much time. This smacks of sheer laziness & incompetence. If they can't handle the 2012 rules, how are they ever going to handle the layers upon layers of bureaucracy coming down the Obamacare pike?

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