Billing Third-Party Payers. Why Start Now?

 

Since World War II local health departments and other safety net providers have provided free (or very low cost) confidential sexual health services to patients through sexually transmitted disease (STD) clinics. These clinics have received funding to provide free services through a variety of local, state and national sources. However, these funding sources are currently in decline. At the state level, ASHTO reported that 50% of state program reported cuts to their HIV and STD programs[1]. Dr. Gail Bolan, Director of the Centers for Disease Control and Prevention (CDC), Division of STD Prevention (DSTDP), stated at the 2015 National Coalition of STD Directors (NCSD) Annual Meeting that, adjusting for inflation, funding for STD clinical services decreased by 36% between 2003 – 2014[2]. In addition to these funding cuts, a recent analysis done by CDC showed that current safety net population (those who remain uninsured and under-insured) far exceed available CDC funding for safety services.[3] Despite declines in public funding for STD testing and treatment services, less than half (45%) of STD-certified 340B clinics bill Medicaid and private insurance plans, and 25% do not bill third-party payers at all.[4] To remedy this lack of billing capacity in STD-certified 340B clinics, CDC funded the National STD-related Reproductive Health Training and Technical Assistance (TA) Centers (STD TAC) to provide billing training and TA to these clinics and public health laboratories and to develop a national STD services billing and reimbursement toolkit.

Got seven minutes? Visit the national STD toolkit, stdtac.org. Like a new year’s “get fit plan”, you know diversifying revenue is good for your organizational health but it is hard to find the time to start. Tools are geared specifically to STD services, and are available in a ready-to-use format. The modules are organized by topic and may be used sequentially or individually. The toolkit is designed to be user-friendly and to ease the significant burden clinics and labs face searching for accurate information or generating needed billing materials.
Got seven minutes? Visit the national STD toolkit, stdtac.org.
Like a new year’s “get fit plan”, you know diversifying revenue is good for your organizational health but it is hard to find the time to start. Tools are geared specifically to STD services, and are available in a ready-to-use format. The modules are organized by topic and may be used sequentially or individually. The toolkit is designed to be user-friendly and to ease the significant burden clinics and labs face searching for accurate information or generating needed billing materials.

While traditional funding sources are in decline, the Patient Protection and Affordable Care Act (ACA) offers new opportunities for billing third-party payers. Millions of previously uninsured Americans now have access to health insurance coverage. In addition, ACA also has provisions for mandated coverage of USPSTF A and B-recommended Preventive Services (including Chlamydia, Gonorrhea, Syphilis, and HIV screening for appropriate populations) in the new marketplace plans. Finally, ACA includes provisions that Qualified Health Plans include “essential community providers” in their networks, increasing the incentives for health plans to contract with safety net providers such as STD clinics.

Implementing or expanding third-party billing is a way to diversify revenue streams, ensure access to care, and potentially expand services to populations who need them the most. In 2015, CDC’s Division of STD Prevention funded the national STD-related Reproductive Health Training and Technical Assistance Centers (STD TAC) to provide training and technical assistance to STD programs nationwide and manage the national STD services billing toolkit.

The new online National STD Services Billing and Reimbursement Toolkit is designed to help publicly-funded STD clinics and public health laboratories make decisions about whether to bill, as well as how to develop billing systems, manage revenue cycles, initiate contracts, and enhance coding capacity. The toolkit is targeted to representatives of STD programs, STD clinics, and state public health labs doing STD testing, who are responsible for aspects of billing and reimbursement policies, protocols, and tasks.

Visit stdtac.org today.

 

[1] The Association of State and Territorial Health Officials, Budget Cuts Continue to Affect the Health of Americans, http://www.astho.org/Research/State-Health-Agency-Budget-Cuts/, Update October 2013

[2] Bolan, Gail. (2015, October) Update from the CDC Division of STD Prevention. National Coalition of STD Directors Annual Meeting.

[3] 2014 STD Prevention Conference. Estimating the Size and Cost of Services of the Safety Net Population for STD Prevention; Laura Haderxhanaj, MPH, MS et. al.

[4] JSI, Third-Party Billing for Public Health STD Services: A Summary of Coordinated Needs Assessment Results, 2014. http://stdtac.org/wp-content/uploads/2016/05/National-Billing-Needs-Assessment-for-PH-STD-Services-Final-March-2014.pdf

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