Billing Landscape Scan

Purpose
Washington County’s Health and Human Services (HHS) department provides services that are billable through Medicaid, Medicare and private insurance. In addition, Department of Housing Services (DHS) has an internal team that is testing the concept of Medicaid billing for direct services and has several contracted providers who are performing Medicaid billing under contract with CCOs. The billing practices these departments currently have in place are limited. Examples of services that may not be currently billing to the full potential include TB direct observed therapy, nurse home visiting, and STI treatment.

In our resource constrained environment, Washington County HHS and DHS are interested in better understanding what untapped billing opportunities may exist, the estimated administrative cost associated with pursuing them, and the most cost-effective method – to determine if/where we might capture additional revenue. We are approaching this in three phases, so that we can use information gathered to determine if/how to proceed at each phase.

Objectives

Phase one (this RFP): Inventory opportunities for increased billing revenue and document existing knowledge and practices related to billing processes and procedures.

Phase two: Conduct a cost benefit analysis to assess opportunities for new/increased billing revenue alongside anticipated costs associated with needed process and procedure improvements.

Phase three: Develop a scope of work for implementing identified improvements and assist with launching new processes and procedures.

Approach

A budget of up to $25k is available for the three phases of this project. Because each phase of this project builds on the last, the scope of work in this RFP encompasses only the first phase . Subsequent phases, if recommended, will be scoped at the close of the current one. Additional funding may be available to execute phase three.

Combining HHS and DHS in this analysis allows both departments to identify shared opportunities that might not otherwise be feasible, and to learn from each other. Both departments have limited administrative capacity. This needs to be considered and reflected in deliverables and proposals.

HHS and DHS have separate organizational structures:

• HHS is a department of 450 staff. It has eight divisions including Public Health (PH), Disability, Aging and Veteran Services (DAVS) and Administrative Services (AS). PH is the largest division with approximately 175 staff in eight branches. DAVS has 29 staff, and AS has 10. (See organization chart in attachments.) Each division under HHS contributes funding to support centralized administrative services (e.g., financial management) and coordinated supports (e.g. project management, data analysis) .
• DHS is budgeted for 115 full time employees. It has two divisions: tenant services and administrative services. In the past few years, the department has experienced dramatic growth and evolved into six primary teams: Finance, Accounting, and Budget; Rental Assistance; Real Estate; Homeless Programs; Business Operations; and Strategic Initiatives and Relations (org chart attached). Across all teams, DHS utilizes braided funding from various funding streams including state, regional, and federal funding that support both divisions.

Additional context that may support this work:

• Systems currently used for referral and billing include but are not limited to EPIC, MMIS, Oregon Access, OCHIN Epic and the UniteUs platform.
• HHS does not have a Federally Qualified Health Center (FQHC) within the Department.