Kansas Local Health Department Clinical Services Coding Resource Guide - 11th Edition Released
The 11th Version of the Kansas Local Health Department Clinical Services Coding Resource Guide (Resource Guide) is now available on the Kansas Association of Local Health Departments (KALHD) website (2024 KS LHD Clinical Services Coding Resource Guide). The guide is funded by KALHD for its Local Health Department (LHD) members creating a common language for public health services.
The first Resource Guide was created over a decade ago by a group of public health professionals identifying the need for greater communication within the LHD between clinicians and billing staff. They understood the basics, including maintaining documentation of services by the LHD and that insurance companies required proper codes to process claims.
Billing staff also brought to the table the complexities of billing faced by LHDs. There are some services they can provide, there are some services they can only provide, and there are others for which they are excluded from reimbursement either by policy or by logistics. There were no external professionals or training sources available to explain this difference to Kansas LHDs, which served as the catalyst to look to themselves to fill the void in LHD billing education.
Working with Wichita State University Center for Public Health Initiatives (WSU CPHI), a written guide was created which outlines the methodologies and current codes used by LHDs. Each subsequent year, a Review Team goes through the guide and makes suggestions for revisions. The 2024 Review Team included eight employees from LHDs, seven representatives from Medicaid Managed Care Organizations (MCO) and others from third-party payers.
The Kansas Department of Health and Environment Division of Healthcare Finance (KDHE DHCF) clinical team played a significant role as a partner this year, providing additional Current Procedural Terminology (CPT) codes and information on services newly covered by Medicaid. Examples of new services include prenatal and OB services by Doulas, nursing education for Elevated Blood Lead Levels, and connections with clients made by Community Health Workers.
The Resource Guide is widely recognized as the “go to” for billing and finance staff. It has also been a vital tool for MCO representatives when resolving claims questions with LHDs.
Melinda McIntyre, Billing Coordinator for Johnson County Department of Health and Environment, was there from the beginning. She said, “For me billing has been learn has you go, trial and error. There was nowhere for training for billers and there were so many billers at the meetings needing help. That’s when a billing guide was created. I felt let’s not recreate the wheel. The guide has gone from a CD rom to this wonderful resource guide.”
Taking this success story a step further than just an internal operations solution for LHDs, it is important to note that public health revenue in Kansas comes from a diverse set of sources. The four primary funding sources are local, state, federal and fee for service. Services covered in the Resource Guide are included in the fee for service category. While that percentage varies from year to year, most recently billing by LHD staff raised $17.7 million or 14% of public health funding. This percentage illustrates the importance of how LHDs understand their role as being part of the solution when it comes to balancing the LHD budget.
The funding raised through fee for service billing goes to offset the costs of providing public health care for Kansas communities. Revenue through this source can cover expenses such as salaries, equipment, medical supplies and other related expenses. It can also assist with the costs of uncompensated care such as disease surveillance and prevention activities.
WSU CPHI thanks KALHD for providing funding for the annual review, KDHE DHCF for their role as an active partner, and to the 2024 Review Team for contributing their time to this process.
If you have questions or would like additional information, please reach out to Tina Payne, Public Health Program Specialist at tina.payne@wichita.edu.
To access the guide, click here.