Fine-Tuned Process Maximizes Cost Savings
When Bee County Judge Stephanie Moreno was appointed in 2015, one of her chief priorities was to address the burgeoning, and seemingly uncontrollable, cost of inmate health care.
“It was the first task I attempted to resolve when I took office because we had essentially no control over this expense, Moreno recalled.
The County Judge spearheaded a process to qualify inmates as indigent and eligible for Medicaid rates.
“Since the inmate cannot work and has no income while he or she is incarcerated, we deem the inmate to be indigent,” Moreno specified. Indigent care is required by Chapter 61 of the Texas Health and Safety Code, known as the Indigent Health Care and Treatment Act, and can be applied to county jail inmates.
“Prior to Judge Moreno, we were only reducing the hospital bills by 40 percent, and the other medical bills were paid in full,” explained Grace Yturria, Bee County’s internal auditor and grant administrator. In 2014-15 and 2015-16, Bee County spent $459,548 and $470,008 on inmate medical care, respectively. When the county implemented its Indigent Inmate Medical Program, the cost savings were immediate:
2016-17
24 inmates with 80 bills processed
$242,954 saved
Highest bill: $27,000 reduced to $3,500
2017-18
40 inmates with 155 bills processed
$453,158 saved
Highest bill: $33,250 reduced to $4,300
“We have seen significant relief with this program, as well as utilizing an onsite medical provider at the county jail,” Moreno shared.
Payment Process Step by Step
“To tweak the paperwork process, there had to be a meeting with all the departments and medical staff to visualize how the paper flow would work best,” Yturria explained. The following steps were put into place:
- Inmates are automatically considered indigent at the time of arrest. Upon arrest, inmates complete and sign form 100A.
- As medical bills arrive at the sheriff’s office, they are date stamped and reviewed by the jail staff to match DOS (date of service) to the inmates’ jail time.
- Booking sheets are printed as proof, form 100A is attached, and papers are sent to the medical staff.
- The medical staff reviews the bills for procedures and pricing. A physician assistant also reviews the same and approves the bills.
- Once approved, the paperwork is sent to the auditor’s office.
- Yturria processes the bills using the Texas Health and Human Services and the Texas Medicaid & Healthcare Partnership (TMHP) websites.
- Hospital bills are reduced by either inpatient or outpatient rates on the ratio of cost-to-charges (RCC) listed.
- All other bills are looked up in the TMHP website by the CPT codes to access the Medicaid rates.
- Yturria reduces the bills, makes copies, and prints invoice coversheets for the accounts payable department to process for payment.
- On the final step, Yturria enters all medical bill data in a spreadsheet format; under Texas Health and Safety Code Section 61.041, it is required to send in monthly and year-end reports in order to seek State assistance. Per statute, there is a threshold of $30,000 spent per inmate, per year.
These qualifying steps have already saved Bee County more than $100,000 in 2019, Yturria noted. One bill for $67,000 was reduced to $5,300, and a second bill for $50,000 was reduced to $4,000.
“This program has helped us in planning our annual budget,” Moreno observed, “and has freed up money to address the ever-growing costs of county government.”