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Home My WebLink About20110014.tiff RESOLUTION RE: APPROVE STATEMENT OF WORK FOR AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA) COLORADO IMMUNIZATION PROGRAM (CIP) REIMBURSEMENT IMMUNIZATION OPPORTUNITY(RIZO) PILOT PROJECT AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with a Statement of Work for American Recovery and Reinvestment Act(ARRA) Colorado Immunization Program(CIP)Reimbursement Immunization Opportunity (RIZO) Pilot Project from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Public Health and Environment, to the Colorado Department of Public Health and Environment, commencing January 1, 2011, and ending December 31, 2011, with further terms and conditions being as stated in said Statement of Work, and WHEREAS, after review,the Board deems it advisable to approve said Statement of Work, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Statement of Work for American Recovery and Reinvestment Act (ARRA) Colorado Immunization Program (CIP) Reimbursement Immunization Opportunity(RIZO) Pilot Project from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Public Health and Environment, to the Colorado Department of Public Health and Environment be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said Statement of Work Oil tuT0.`yyC� C NL 2011-0014 J I- (3'-f -I i HL0038 � I - 3 1t STATEMENT OF WORK FOR AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA) COLORADO IMMUNIZATION PROGRAM (CIP) REIMBURSEMENT IMMUNIZATION OPPORTUNITY (RIZO) PILOT PROJECT The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 3rd day of January, A.D., 2011. BOARD OF COUNTY COMMISSIONERS W D COUNTY, CO ORADO ATTES{ �+ arbara KirkmeykChair Weld County Clerk to the -r• , C' I y0 •ean P C , Pro-Tem BY: !. I R. Deputy Clerk to the Bo-%c, 4,/ ` I 1 Wil F. Garc - • E �C APP :�" �i= David E. Long County Attorney =-(sr (�, � - z Dougla Rademach r Date of signature: /ate 2011-0014 HL0038 cit re"----- 6 & tw:, DEPARENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17TM`h Avenuee Ll Greeley, CO 80631 Public Health Web: http://www.weldhealth.org C. Memorandum COLORADO Date: December 15, 2010 To: BOCC From: Mark E. Wallace, MD, MPH - Director Re: Proposed agreement for review In this memo you will find a proposed agreement discussed with Commissioner Conway on December 15, 2010. The proposed agreement for funding and scope of work summarized in this memorandum represents a pilot program evaluating the readiness and functionality of public health to bill third party payers for immunization services. Please review this agreement and indicate if you would like a work session prior to placing this item on the Board's agenda. 1. ARRA Colorado Immunization Program, RIZO(Reimbursement Immunization Opportunity)Pilot Project Statement of Work—Over time, all billing for clinical services to third party payers, including Medicaid and Medicare,will only be done electronically.This statement of work involves participation in the RIZO pilot program to develop the capacity for billing health insurance for immunization services provided to health plan members by local public health agencies.The Department currently provides immunization services to people with Medicare, Medicaid, and other third party insurance.The program will involve the following: collecting data to determine if electronic billing for reimbursement of administration fees and vaccine costs is a sustainable and cost effective process; funding to increase our capacity to bill third-party payers electronically; and funding to train staff members in electronic billing processes for third-party payers. Because our department is farther along than other health departments in electronic records and billing for services, one of our billing technicians will also serve as a mentor to other local public health agencies regarding billing Medicare. The proposed agreement is between the Colorado Department of Public Health and Environment, Colorado Immunization Program and the Weld County Department of Public Health and Environment(WCDPHE). The proposed amount of funding is $32,500 for the time period January 1, 2011 through December 31, 2011.The funding will pay for existing staffs time committed to testing and evaluating electronic billing. Since all billing will ultimately be done electronically we recommend your approval of this grant funding to enable us to participate in the pilot and reduce County costs during the testing phase. A work session can be held at your request if desired. Request work session Approve B0CC agenda Sean Conway O Yes RI No RYes O No Bill Garcia O Yes IZI No a Yes O No Barbara Kirkmeyer O Yes W, No n Yes O No Dave Long ❑ Yes No Yes O No Doug Rademacher O Yes PJ No Pi Yes O No DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 lee. lisellPublic Health M..: 1 IWeb: http://www.co.weld.co.us/departments/healthenvironmentl EI Health Administration Public Health 8 Clinical Environmental Health Communication, Emergency Preparedness W ic9e7s0 304 6420 c9e7s0 304 6415 TileRlees9p7o0n3s0e4 6420 452 Fax C. Our vision'Together with the communitieswe serve,we are working l o Ong to make Weld County 970 th health)est place to lore,970 304 work anti play COLORADO TO: Douglas Rademacher, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH, Executive Director Department of Public Health and Environment -6,62 DATE: December 15, 2010 SUBJECT: ARRA Colorado Immunization Program RIZO Pilot Project Statement of Work Enclosed for Board review and approval is the ARRA (American Recovery and Reinvestment Act) RIZO (Reimbursement Immunization Opportunity) Pilot Project Statement of Work between the Colorado Department of Public Health and Environment, Colorado Immunization Program and the Weld County Department of Public Health and Environment (WCDPHE). The proposed amount of funding is $32,500 for the time period January 1, 2011 through December 31, 2011. The statement of work involves participation in the RIZO pilot program to develop the capacity for billing health insurance for immunization services provided to health plan members by local public health agencies. The program will involve the following: collecting data to determine if electronic billing for reimbursement of administration fees and vaccine costs is a sustainable and cost effective process; funding to increase our capacity to bill third-party payers electronically; and funding to train staff members in electronic billing processes for third-party payers. One of our billing technicians will also serve as a mentor to other local public health agencies regarding billing Medicare. I recommend your approval of this statement of work for the RIZC Pilot Project. Enclosure 2011-0014 STATE OF COLORADO Bill Ritter,Jr.,Governor o1• dtpep Martha E. Rudolph, Executive Director ,�� Dedicated to protecting and improving the health and environment of the people of Colorado ,", 9 o 4300 Cherry Creek Dr.S. Laboratory Services Division * $ r Denver,Colorado 80246-1530 8100 Lowry Blvd. •1876` Phone(303)692-2000 Denver,Colorado 80230-6928 TDD Line(303)691-7700 (303)692-3090 Colorado Department Located in Glendale,Colorado of Public Health http://www.cdphe.state.co.us and Environment 2010-2011 American Recovery and Reinvestment Act (ARRA) Colorado Immunization Program (CIP) RIZO Pilot Project Statement of Work Agency Name: Weld County Department of Public Health and Environment ARRA-funded Project: RIZO Pilot Project The Colorado Immunization Program (CIP) at the Colorado Department of Public Health and Environment (CDPHE) will utilize American Recovery and Reinvestment Act (ARRA) resources to develop the capacity for billing health insurance plans for services provided to health plan members by local public health agencies (LPHA). These funds will support LPHA with a new pilot program opportunity called "Reimbursement Immunization Opportunity" or RIZO. The RIZO pilot program will involve the following: • Collect and analyze patient data as requested by the Colorado Immunization Program to determine if reimbursement for admin fee and vaccine cost is a cost effective / sustainable process. • Fund the development and/or improvement of LPHA infrastructure and processes that lead to successful third-party (public and/or private) billing mechanisms for the immunization of insured patients. • Third-party billing will include billing of the vaccine administration fees, and potentially the vaccine cost for private-stock vaccines only. • Participation of both experienced and inexperienced third-party billers. • Participants located in both rural and metro areas of Colorado. Grant Information: Funding period 1/1/11 — 12/31/11 Starting the project Work is not to begin on the proposed project until the grantee receives an approved contract or purchase order from the CIP. ARRA-required All ARRA funded projects are required to comply with the Federal and reporting CDPHE ARRA grant reporting requirements. 1 Monthly online progress reports are due the last working day of each month for that month's activities. The online link to the monthly report is: http://fs9.formsite.com/ColoradolMMprogram/ARRARIZOMonthlVReport/inde x.html Additional follow-up contact will be made periodically by the RIZO Project Manager and/or the CIP contract monitor. Required reporting All projects will collect, track and report the following data as applicable. elements Mentors are responsible for collecting the below listed data for their own jurisdiction. Likewise, mentees will collect this data for their own jurisdiction): • Personnel hours and/or FTE used • #jobs created and #jobs maintained with this funding • Description of job positions created and/or maintained • Number of claims submitted to each payor, broken out by dollars paid, denied and pending • Number of claims paid, partially paid, and denied, as well as those with no response • Most frequently received denial reasons • Status of project-specific milestones as documented on the application timeline • Populations Served (payer source, vaccine type, etc., as requested by CIP) ARRA-required terms All contracts and grants involving the use of ARRA funds must include certai and conditions provisions. These provisions can be viewed in the attached document entitled "State of Colorado Supplemental Provisions for Contracts, Grants, and Purchase Orders Using Funds Provided under the American Recovery and Reinvestment Act of 2009 As of 8-21-09". Project monitoring Throughout the funding period, the CIP will conduct ongoing project monitoring and provide technical assistance as needed. In the event that project performance does not meet the agency's stated goals, a follow-up work plan will be created and additional technical assistance will be provided. In an extreme situation, and in consultation with the agency, the CIP reserves the right to reduce or withhold quarterly payments due to poor project performance. Payments Contractor will invoice the CIP quarterly using the invoice provided. Project continuation The possibility exists for this project to be continued in future years if funding allows. 1. Please provide the following information: Agency name Weld County Department of Public Health and Environment Agency mailing address 1555 N. 17th Avenue, Greeley, CO 80631 Phone number 970-304-6410 Fax number 970-304-6412 2. Who is the contact person for this project? Name I Judy Nero 2 Phone number 970-304-6410, ext 2122 Email address jnero©co.weld.co.us 3. Project Plan: A. Goal: (intended outcomes of the plan - can be more than one) B. Objective(s): (events/actions that lead to the goal - clear and measurable) Write your objectives using the SMART objective process: Specific: Identifies a specific event/action that will take place Measurable: Identifies (measures) the amount of change to be achieved Achievable: The objective is achievable and realistic Relevant: The objective is logical and relevant to the overall goal Time-phased: List a time by which the objective will be achieved C. Steps/Activities to accomplish the objective(s): (outline steps to meet each objective) D. Measurement of objective accomplishment: (how will you know the objective is accomplished?) Goal #1 To increase Weld County Department of Public Health and Environment (WCDPHE)µcapacity to,bill health insurance planselectronically for immunization services provided"to health plan members'. Objective #1-1: To bill Immunization Services to Medicaid, Medicare, CHID, and Private insurano Health Care Financing Administration (HCFA) claims electronically with Electroni Data Interchange (EDI) through our EMR/PM system by June 2011. Steps/Activities 1. Coordinate with EMR/PM system technical support to program the existinc system to process our Public Health insurance claims electronically. 2. Meet with technical support to assess what changes and requirements are needed to send claims electronically. 3. Technical support will make changes to the EMR/PM system to populate correct information on HCFA claim forms. 4. Process test claims through system and EDI. 5. Test system in processing claims independently and accurately from both Public Health facility and Community Health Center. How will you know Electronic claim submission tests process successfully. the objective is met? Objective #1-2: Verify codes, fees, and billing fields are correct in the EMR/PM system by March 2011. Steps/Activities 1. Verify CPT and ICD-9 codes in the EMR/PM system to insure the correct codes transfer to claim forms. 2. Verify all needed billing fields (such as: signature on file, patient demographics, insurance information, provider information, clinic information, place of service) populate on claim form and make any changes or corrections as needed. 3. Verify fee schedules. 4. Verify insurance companies' information is entered correctly. How will you know Correct information is populated on test claims. 3 the object is met? Objective #1-3: Review and process claim denials by August 2011. Steps/Activities 1. Utilize tracking system to help determine denial errors. 2. Contact insurance companies for clarification of denial codes and/or reasons. How will you know Both paper and electronic claim denials processed will improve by 60%. the objective is For every 5 claim denials, we will decrease to 2 claim denials after following our met? steps/activities. Goal #2 Train billing technicians (2), financial screeners (5), and agency health care workers(27) on billing processes to:insure correct information is put in the system by,May 2011. ° *An upgrade to our EMR/PM system'it scheduled to be implemented in October 2010. This upgrade may present additional training needs. Objective #2-1: Insurance technician will train 2 billing technicians on correct coding an, information needed on HCFA claims for submission by May 2011. Steps/Activities 1. Train to verify correct CPT codes and ICD-9 codes are on claims. 2. Train to verify claim form is completed with required and accurate information. Familiarize technicians with private insurance companies' requirements. 3. Train to process claims electronically. 4. Train to process denials and resubmissions of claims electronically How will you know To change the 80+ paper and electronic claims processed in a month manually b the objective is processing 60 claims electronically from the EMR/PM. met? Objective #2-2: Insurance technician will train financial screeners by May 2011. Steps/Activities 1. Train on screening patients with insurance as what to ask for and put in the PM system. 2. Create a script for calling insurance companies' to verify benefit coverage and deductibles. 3. Create fee schedule for financial screeners to refer to when giving cost estimate to patient. 4. Review information needed in PM system. How will you know Financial screeners are able to obtain all insurance information needed and put i the object is met? system correctly by May 2011. Objective #2-3: Insurance technician will train agency health care workers for accurate coding fo immunization services. Steps/Activities 1. Review administration fees and vaccine fees. 2. Review procedure coding and diagnosis coding for immunizations when agency health care workers chart in the EMR, to insure procedure code matches correct diagnosis code as this will transfer to claim form. 3. Train one-on-one as necessary. How will you know Agency health care workers are able to chart procedures and diagnosis for the objective is immunizations to meet requirements for all third party payers. met? 4 4. RIZO Mentor Overview & Responsibilities RIZO Mentor Overview • Mentoring Subject Matter Expert for: Medicare (co-chair with Mesa) • The purpose of a RIZO mentor is to be a resource to other agencies that are in the preliminary or early stages of third-party billing. This could include providing guidance on the basics, such as how to pursue a contract with a specific payer or how to process a claim. As your own agency pursues its RIZO goals and gathers more learnings, it is expected that that any relevant knowledge is also passed down to mentees. • Mentors are not expected to have all the answers, but are required to guide and/or assist mentees in how they might track down the necessary information for the specific workgroup/payer-type they are assigned. Continued willingness to perform these tasks will result in full mentor payment to your agency. • Distribution of the $7500 mentor funds will be paid in two equal parts: Dec 2010 & June 2011. Please note that you are not required to document your time, but your mentees may be asked to report on your responsiveness. • Mentoring funds are intended to support your interaction with other RIZO contractors only. Currently there are 10 RIZO contractors, including mentors. Your agency will have mentoring interactions with ≤5 RIZO contractors at any given time. There is potential for Project RIZO to add as many as 5 additional LPHA contractors in 2011, once the initial mentees require less mentor support. RIZO Mentor Responsibilities • Identify the appropriate internal subject matter expert(s) at your agency for RIZO mentoring and provide to the Colorado Immunization Program (CIP) in the SOW. • Work with your mentor peer to develop a resource sheet for your assigned workgroup with known contacts, links and FAQs relevant to that workgroup/payer-type. This document should be supplied to CIP within two weeks of the project start date using the CIP-supplied template. Update document as needed throughout project. • For educational purposes only, mentors will provide CIP with a copy of each existing contract between your agency and a public or private insurance payer, along with a completed "Insurance Payer Contracting" form that outlines the process taken to develop the contract. Confidential or privileged information may be blacked out, where necessary. Copies should be supplied to CIP within one week of the project start date. • Participate in and/or facilitate conference calls with assigned workgroup. • Maintain availability via phone and email to respond to inquires from other RIZO contractors within 1-3 business days. • Agree to occasional travel requests, as needed, to assist in training or possible face-to-face workgroup sessions. Travel may be negotiated directly between mentor and mentee, based on agreed-upon need. Travel expenses do not need to be reported to CIP, but you should notify the RIZO Project Manager of any travel you've planned as part of your mentoring duties. 5 5. Timeline: List the monthly activities your agency plans to complete to meet your goal(s) for this project. Description of the planned activities Additional comments Jan 2011 Meet with IT staff to process test client information. Check information and charges to evaluate system changes for accuracy. Implement any changes that need to be made. Meet with EMR/PM IT staff regarding system to determine needs to set up for electronic billing. Research private insurance companies' for requirements needed on claim submissions. Meet with IT staff to implement appropriate changes in system. Feb Examine test clients information for accuracy and follow-up with IT staff with any system issues. Mar Process test claims electronically with EDI. Make note of any denied claims and reasons. Train financial screeners and billing technicians. Train agency health care workers on coding and charting. April Meet with IT support to address denial issues. Process test claims and resubmit denied claims with EDI. Train financial screeners and billing technicians May Follow-up meetings with financial screeners, billing technicians and agency health care workers to address any concerns or changes with billing process. Process test claims with EDI. June Process claims electronically with EDI. Analyze results and follow-up with IT staff with any system issues in billing process. July Process claims electronically August Process claims electronically. Review and process claim denials. Sept Process claims electronically. Follow-up with billing technicians and financial screeners regarding any concerns or changes to billing process. Oct Process claims electronically. Review insurance response time and accepted claims processed. Nov Process all Medicaid, Medicare, CHP, and private insurance claims electronically. Dec Process all Medicaid, Medicare, CHP, and private insurance claims electronically. 6 6. Barriers: What problems must be solved or obstacles overcome to commence and complete the project? How do you plan to address them? The primary challenge for us is we share our electronic health record system with a Community Health Center. The system needs to process claims for both agencies independently. The Community Health Center processes claims differently than Public Health. We will work closely with technical support to maintain independent billing systems and monitor any issues in the billing process that will cause denial of claims for either agency. 7. What support/guidance would you need from the Colorado Immunization Program to overcome these barriers? Funding to support technical assistance and software programming. Funding for additional training of staff. 8. Evaluation: All funded agencies are required to have a detailed evaluation plan in place at the time of application. A final comprehensive evaluation report will be submitted by the grantee at the end of the project period. Include your project evaluation plan here and ensure it includes the following information: A. What specific aspects of the program will be evaluated when judging project performance? Successful electronic billing of claims to Medicaid, Medicare, CHP, and private insurance companies. B. What standards (i.e. type or level of performance) must be reached for the project to be considered successful (overall target performance measures)? Standards met will show a successful project, would have to have the ability to bill electronically and have claims process successfully. C. Include process measures (description of the extent to which the project was implemented according to the project plan). Measures will include updates to EMR/PM system for electronic billing, successful training logs for personnel to assist with the billing process, and monthly reporting to determine how beneficial billing private insurance will be for our facility. D. Conclusions (analyze data/results, interpret results, judgment, recommendations) Data will be analyzed via Excel spreadsheets to document claims processed for each insurance company billed (Medicaid, Medicare, CHP, and private insurance). Assess whether this project is sustainable/cost effective when processing claims for 1) admin fee only 2) admin fee + private-stock vaccine. E. Ensure use and lessons learned (feedback, follow-up, dissemination) Follow-up meetings will be scheduled routinely to address concerns or more training needs. F. What is the future plan for using the project process and outcome data to improve immunization services? The plan is to provide for more opportunities for clients with private insurance to utilize their insurance at the health department when their Medical Home does not provide services. This will allow us to serve an increased population with immunization services. 7 9. Budget Expenses Describe in detail Proposed Local Total funding In-kind Budget Personnel .15 FTE Insurance Tech, .05 FTE Billing $14,990 $3,254 $18,244 Tech, .05 Financial Screener, .01 FTE Public Health Nurse, .025 FTE Project Coordinator Travel Mileage expense to meet with technical 75 75 support staff and staff from Community Health Center Marketing $0 Incentives $0 Equipment $0 Office Copying, general office supplies 300 300 supplies Indirect CDPHE 2010 negotiated rate of 12.41% 2,760 699 3,459 Other IT Support time and Software program 7,250 2,000 9,250 changes — Costs include - OnlineTraining/Setup, Electronic claims and remittance from EMR/PM system per FTE provider per month, cost per claim sent by Vendor, and eligibility verification.* RIZO Mentor activities 7,500 7,500 Total $32,500 $6,328 $38,82 *These costs are necessary for our agency to be able to bill electronically. 10. Any additional information you'd like to add? WCDPHE has two locations where immunization clinics are held. The populations seen at each clinic are different. At our Southwest Complex, we serve clients who have private insurance, but their medical home providers do not administer vaccines in their practice. These clients are referred to our facility for immunizations. Clients also state their providers do not administer vaccines at their facility because of the increase in parental refusal to vaccinate their children. As a public health department, we value protecting the community from harmful diseases by administering immunizations. Most medical providers require a child to have a well-child exam in order to receive vaccinations where the Health Department provides immunizations without a well-child exam. Pay sources for our clients are limited. Our travel clinic is the only clinic where clients in Weld County can receive immunizations to travel abroad. WCDPHE is here to serve clients who don't have anywhere else to access vaccination services. 8 11. ARRA-specific deliverables: Number of FTE/jobs created for the project period Number of FTE/jobs retained for the project period .15 FTE Insurance Tech, .05 FTE Billing Tech, .05 Financial Screener, .01 FTE Public Health Nurse, .025 FTE Project Coordinator The number of jobs created/retained can be calculated as: FTE = Cumulative Hours Worked that were funded by the Recovery Act Cumulative Hours in a Full-time Schedule (2080) Examples: A person working full-time for 1 year= 1 FTE. A person working half-time for 1 year= .5 FTE. A person working full-time for 3 months = .25 FTE. LOCAL HEALTH PARTNER ACCEPTANCE OF THE 2010-11 American Recovery and Reinvestment Act (ARRA) Colorado Immunization Program (CI?) RIZO Pilot Project Statement of Work requirements: I, Barbara Kirkmeyer , on behalf of The Board of Weld County Commissioners hereby acknowledge that the requirements for the above-named Immunization Service Purchase Order have been reviewed, and are accepted and agreed to. I further acknowledge that I have the necessary authority to sign this acceptance on behalf of the entity mentioned above. "44-(4_ Chair 01/03/2011 .gnature Title Date 9 ,72C/ —G''D/7 2010-11 CIP ARRA RIZO Invoice INVOICE Agency Name: Weld County Department of Public Health and Environment Invoice #(if applicable): Today's Date: Billing period: TO: Teri Lindsey Colorado Department of Public Health & Environment/ Immunization Program 4300 Cherry Creek Drive South DCEED-IMM-A3 Denver, CO 80246-1530 EXPENSES DESCRIPTION AMOUNT Personnel Travel Marketing Incentives Equipment Office Supplies Indirect Other TOTAL DUE $ Name of agency staff authorized to complete this invoice: Agency Address: City: State: Colorado Zip Code: Agency Tax ID #: Purchase Order# / Contract Routing #: 10 Hello