Introduction of Billing into a Public Health STD/Family Planning Clinic

Background: Denver Metro Health Clinic (DMHC) is a fully integrated STD and Family Planning Clinic located within Denver Public Health. DMHC has 20,000 visits and 15,000 unique patients annually with a current annual operating budget of $2.7 million. With the passage of the Affordable Care Act and anticipated reductions in funding, DMHC initiated efforts to collect revenue through billing for services provided.

Methods: In order to start billing in the DMHC, beginning in November 2012, we worked through eight domains: Assessing the cost of clinic activities, Determining levels of service, Estimating potential revenue, Establishing processes for enrolling patients in appropriate insurance program, Establishing processes for documentation of services, Assessing the need for alternations in clinic flow, Developing a communication plan with internal and external partners, Determining how to evaluate and promote quality improvement. Each of these domains required our attention and were regularly addressed through committee, staff and leadership meetings.

Results:Our current payer mix is: 78% uninsured, 15% Private and 7% Medicaid.  For the most recent month of October 2013, DMHC billed for $377,000 in services provided. Though receipt of payment on these charges is only 0.84% due to our current payer mix, this value is expected to increase with the expansion of the Colorado Medicaid program to include all individuals under the 133% Federal Poverty Level and new options for coverage under the exchange. Denver Public Health is actively assisting patients to enroll in an insurance program and has successfully enrolled 104 patients who were previously uninsured (October 1-November 20, 2013). 

Conclusions: The shift to billing in our STD and Family Planning clinic has been challenging. By the end of 2013, billing revenue will only cover <1% of our total clinic expenditures. Despite this, DMHC is dedicated to continue to increase revenue via billing through quality improvement efforts and increased enrollment of patients in payer plans.