Improving the Appropriate Collection of Revenue at a Local Health Department: The Medicaid Title XIX Match QI Project

Summary

Impact Statement: 
By implementing more accurate Medicaid billing procedures that resulted in an increase in Medicaid match revenue, the local health department was able to re-direct funds to necessary departmental strategic priorities that benefit the health of the local community.
Summary: 

Revenue collected through reimbursement for Medicaid (Title XIX) match activities had been trending downward for 2 years for the Tacoma-Pierce County Health Department. Additionally, the Washington state contractor hired to implement a new tracking and submission process for Medicaid match reimbursement indicated that health departments in similar communities received substantially more reimbursement than the Department had historically received. The Department did not understand the operational claiming and invoicing mechanisms that had resulted in an approximate 60% underbilling for Medicaid administrative work already being performed. An opportunity existed to determine if improvements in our processes, coding, and practices could result in more accurate reimbursement levels, which would then lead to increased revenue for the Department from the Medicaid administrative match activities. A quality improvement (QI) project team was assembled to increase Medicaid match dollars appropriately reimbursed to the Department annually by at least 30% within the next three billing cycles (three quarters). The team followed an improvement cycle based on the Juran trilogy and used several QI tools, such as root cause analysis, work flow analysis and cause-and-effect diagrams, to identify causes and solutions to the problem. The project resulted in three intervention cycles of training and education of staff participants in the Medicaid match program. Each of the intervention cycles led to an improvement in the operational claiming mechanisms, which led to increased revenue. The Department used the increased Medicaid match revenue to free up flexible dollars formerly used to supplement programs that participate in Medicaid administrative work and redirect those dollars to new priorities in the Department’s strategic plan.

Organization that conducted the QI initiative: 
Tacoma-Pierce County Health Department
Citation: 

Vance, D. Public Health Quality Improvement Exchange. Improving the Appropriate Collection of Revenue at a Local Health Department: The Medicaid Title XIX Match QI Project . Thu, 11/07/2013 - 15:03. Available at https://www.phqix.org/content/improving-appropriate-collection-revenue-local-health-department-medicaid-title-xix-match-qi. Accessed May 27, 2018.

Submission Status: 
Completed
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