The Leon County Health Department's (LCHD) Increased Medicaid Reimbursements to Enhance Breast/Cervical Cancer Screening Project is designed as a quality initiative to fill the service gap not met by existing programs—the Mammography Project and the Florida Comprehensive Breast and Cervical Cancer Early Detection Program (FBCCP). The Mammography Project is limited to physician referrals of asymptomatic women 40 and older that meet financial eligibility criteria. The Florida Comprehensive Breast and Cervical Cancer Program focuses on women 50 to 64 years of age who meet financial eligibility criteria. The eligibility specific criteria for these programs have created a service gap for under/uninsured women presenting with physical, clinical findings and/or personal or family history of breast/cervical cancer. This project was designed to fill that gap.
The original expected outcome of the project was to provide services to 50 percent of the estimated 100 ineligible women identified; however, services have been provided to 60 percent of the identified participants. The ICHD has been able to replicate the process annually because it has identified service gaps of the target population and has organized:
Staffing and required time commitment
Community health care resources
Agreements and collaborations with community partners.
The project objectives are to:
Maximize Medicaid reimbursement
Redirect the generated revenue for mammography services
Establish a referral sources
Increase by 50 percent screening for 100 potentially ineligible sexually active women
Enhance community education and recruitment efforts
Develop a plan to address implementation, follow-up, outreach, education, data collection, and evaluation.
Cancer is the second leading cause of death in Florida and ranks among the five leading causes of death in Leon County for women age 40 and older. The breast and cervical cancer death rates among women 40 and older in Leon County perhaps reflect the fact that approximately 17 percent of the residents are at or below the poverty level and may be underinsured or uninsured. Quality assurance assessments and patients requests for services prompted the evaluation of existing programs. This revealed a barrier in the provision of needed screening services for women who did not meet program-specific eligibility criteria for those programs. The Process Improvement Team was created to identify alternative funding sources to fill in the gap for missing cancer-screening services. The team brainstormed and decided to look for funding within current programs at the health department. They decided that revenue generated from increased Medicaid reimbursement would be an ideal means of paying for needed services.
Costs and ExpendituresData collected through the case management process indicated that the cost of executing the program amounted to approximately 15 percent of the case manager's time ($6,000).
ImplementationFrom December 6, 1999 to June 1, 2000, the LCHD took the following steps to implement this program:
Attended Medicaid Reimbursement Committee Process Management Training.
Arranged staff meetings to discuss the project.
Evaluated the current billing process for Medicaid and mapped in the Process Flow chart.
Developed a to improve Medicaid billing, established strategies to address the problem and created improvement activities.
Developed a Final Flow Chart of Process.
Contacted target population and set appointments.
Recruited new participants through outreach and clinic activities and set appointments.
Once they launched the program, the LCHD:
Monitored Medicaid billing process.
Conducted a three-month evaluation and created strategies to address deficiencies.
Conducted six-month evaluation and follow-up of the project.
Documented the project results and lessons learned.
The goals of this project were fully realized. The project was evaluated using fiscal and case management data. The Fiscal Department provided Medicaid revenue for six months prior to the project implementation and six months after implementation of the project. Medicaid revenue for the six months prior to the project was $18,630.92 and the Medicaid revenue for six months after the project was $47,466.79. This represents 155% increase revenue generated by Medicaid.
The project's improved Medicaid billing process enabled the health department to generate more funds thereby providing needed services for ineligible women. The case management component identified women ineligible for needed services and provided a tracking mechanism for these women. Over 60% of ineligible women received services.
SustainabilityUsing the plan developed to improve Medicaid billing, the HD has been able to maintain an increase in the reimbursement rate, which in turn has allowed for increased monies for needed mammography services. Each year, as a part of the budgetary process, $5 thousand is allocated in the general revenue funds for this purpose. Moreover, partnerships with agencies in the Leon County area have resulted in agreements that provide service at a reduced rate. With the lower cost of mammograms, more screenings can be offered to patients.The LCHD implements the program by piggybacking on the FBCCP and the Mammography Project. This process, provided as an in-kind contribution, allows all funds generated by the plan to be used solely to provide patient services.
Staff input is vital to the success of the project.
Staff education is an absolute necessity throughout the entire process from initiation to completion.
Monitoring the Medicaid billing process must be ongoing.
Allotment of staff's time is vital to the process.
Key Elements Replication
Identify of service gaps of the target population.
Organize staffing and required time commitment, community health care resources, funding sources, recruitment methods, and agreements and collaborations with community partners.