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.