Public
Healthcare

Revenue Cycle
and Billing

Backflow Prevention in Public Health

by | Jul 7, 2020 | Affordable Care Act (ACA), American Exchange News, Government Programs, main post

There is a very simple device that we all have in our homes that we may never think of. When I say the term “back-flow preventer,” unless you are a plumber, this may be the first time you have read this term in ten years. This device is used to keep contaminated water from flowing back into the potable water supply. If water pressure fails, then soil and other pollutants can flow back into the house, causing all sorts of problems. Problems can arise from a plethora of reasons, including burst pipes, not being able to use a fire hydrant or critically high demand on the water supply. No matter the reason, the back-flow preventer stops it. It is a thankless job, and you only really think of it when it isn’t working properly.

Our public health system works in the same capacity as the back-flow prevention. It is also a thankless job that provides a massive public service and only gets noticed when there is something wrong. Since the onset of Covid-19, many of the systemic issues have come to light. These souls are the front-line workers, testing and combatting this virus. They are working in rural and urban areas, trying to reach all populations. In some respects, it almost seems like the Spartan King, Leonidas, and his 300 man army trying to hold off the overwhelming Persian forces whilst the rest of the Greeks scramble to respond.

Before we dive into what the problem is, I think it is important to see what the health department actually does. Not many people know the wide range of services provided at these facilities. In the 1950’s, the American Public Health System was a beacon to the world for public health. They were the leaders in combating diseases such as polio and TB. Today, health departments provide 97% of ALL newborn testing for metabolic and other genetic disorders. So let’s take a look locally at what health departments in the State of Tennessee provide:

  • Child Health
  • Immunization Shots
  • Primary Care
  • Family Planning
  • STD Control
  • TB Control
  • Women, Infant and Children (WIC) services
  • Children’s Special Services
  • Prenatal Care
  • HUG (Help Us Grow, home visits for children at risk for developmental delays)
  • Vital Records
  • Health Education
  • General Environmental Health
  • Voter Assistance Programs
  • TENNCare Outreach

As we can clearly see, public health departments provide more than just condoms and brochures. So, if this is such an important and vital cornerstone of our society, why are we seeing such a decline in staff and services? The issue is funding, plain and simple. Why is funding such an issue? Well, when public health is working, life goes on normally. So, while life is going on normally, it appears to some that the money for public health isn’t needed; thus, the funds could be used elsewhere. According to the Affordable Care Act (ACA), a “Prevention and Public Health Fund” was established to the tune of $2 billion dollars a year by 2015. Nothing was really going on, so the Obama administration pulled the funding to pay for a payroll tax-cut. Now, the Trump administration wants to completely do away with the ACA which would eliminate those special funds all together. So, instead of viewing these funds as an investment, they are viewed as a reservoir of funds to be used on whatever the current hot-button issue is.

You may be asking yourself, “What does that actually mean?” Health Departments are having to operate extremely lean with one arm tied behind their back. In addition, they have their regular populations they have to serve, as well as the incoming Covid-19 patients. They have to extend their resources as far as they can, and every penny counts. The problem with this is that the medical reimbursement system is one of the most complicated systems on the planet. What we have found is that these departments are having to use case workers or accountants that really have no clue how the medical coding and billing works trying to control the revenue flow. Plus, they are still having to do their regular jobs. Directors are having to make a tough decision: pour funds into their outreach – you know to do what they are supposed to – or pay for internal billers? Under this model a sacrifice has to be made somewhere.

If funding from the state/federal government is finite, what do you do? The simple answer is to find other revenue sources. How do you do that? The first step is to streamline billing processes. It doesn’t make a lot of sense to put a new engine in a boat when there is still a hole in the bottom. American Exchange (AE) has found that there is often lost revenue due to under billing. We have been able to work with public health departments to find those holes and plug them. The second step is to be credentialed with as many carriers as you can. This step opens up more revenue sources and allows the public health departments to be able to reach a wider patient population. Why let a little paperwork leave thousands of dollars on the table? The third step is to offer enrollment resources to existing patients. There are many programs that offer premium and co-pay assistance for various conditions. The obvious benefit of this is being able to bring in more revenue. The hidden, and in my opinion, bigger benefit is that this will lead to an improved community health overall because it increases access to care across the spectrum.

While working through these three steps in billing, credentialing and enrollment services with our public health department clients, they have seen that increase in revenue as well as human resources. Since they don’t have to pay for someone to just handle billing, they can spend the money on outreach and programming.

American Exchange (AE) stands in solidarity with the community we are part of, and together we stand at a precipice. No one knows what the next six months will look like. However, the one thing that is certain is that there must be policy changes for public health services. We need to support the real front-line workers in whatever way we can. In summation, American Exchange (AE) has found the best way to support our communities is to provide resources through revenue growth.