T HE IPHA HIV T HIRD -P ARTY B ILLING P ROJECT Jeffery Erdman Illinois Public Health Association Billing Stakeholder Advisory Group Meeting August 26, 2019
W HY B ILL T HIRD -P ARTY P AYERS FOR HIV AND O THER P REVENTIVE H EALTH S ERVICES ? In an era of dwindling public funding, HIV/public health providers need to maximize revenue capture to continue to provide essential public health services, such as HIV testing and immunizations. HIV/public health providers offer safety net coverage: ensuring that low-income clients, many newly insured under the Affordable Care Act (ACA)/Medicaid, still have access to public health services. More clients with insurance means more billing (revenue) opportunities to maintain staff/services or to expand services to other vulnerable populations (i.e., clients eligible for PrEP).
IPHA E XPERIENCE WITH T HIRD -P ARTY B ILLING FOR P UBLIC H EALTH S ERVICES Through a five-year CDC Harmony grant, IPHA assisted nearly Health Alliance 85 LHDs, serving rural and HealthLink urban counties throughout HFN Illinois, with capacity- building to bill for Humana immunizations and other IlliniCare preventive health services to Meridian patients covered by Medicaid, Molina Medicare and the major insurance carriers in Illinois: United Healthcare Aetna BlueCross BlueShield of IL Cigna Coventry
IPHA E XPERIENCE WITH T HIRD -P ARTY B ILLING FOR P UBLIC H EALTH S ERVICES At the outset of the grant, 10 LHDs projected that total revenue earned over two years from billing Medicaid and commercial insurers would be $420,000. At the end of the grant’s second year in 2014, total reported revenue earned by these LHDs from billing Medicaid and commercial insurers was $911,000 – an increase of 116 percent from projected numbers. By the grant’s end in 2017, nearly 85 LHDs in Illinois were billing third-party payers for public health services, and total revenue earned by the 30 LHDs contracted with the project’s billing vendor had exceeded 8 million dollars!
IPHA HIV T HIRD -P ARTY B ILLING P ROJECT From 2018-2020, IPHA and CDP are partnering on the HIV Billing Grant to: Credential and contract 5 local health departments (LHDs), community-based • organizations (CBOs), or healthcare providers (HCPs) with Medicaid or Medicaid Managed Care Organizations (MCOs). Assist 5 local health departments (LHDs), community-based organizations • (CBOs), or healthcare providers (HCPs) with the implementation of billing for HIV testing and/or HIV prevention services. Implement an electronic health record (EHR) and/or a revenue cycle • management (RCM) system with 5 local health departments (LHDs), community-based organizations (CBOs), or healthcare providers (HCPs). Assist 5 local health departments (LHDs), community-based organizations • (CBOs), or healthcare providers (HCPs) with the implementation of new billing capacities (HIV treatment, PrEP/nPEP, partner services, medication adherence). Offer six capacity-building webinars, a series of best practice white papers, and • a billing/coding manual for local health departments (LHDs), community-based organizations (CBOs), and healthcare providers (HCPs) to increase their competency in third-party billing concepts, such as contracting/credentialing, billing/coding, and revenue cycle management/electronic medical records implementation.
IPHA HIV T HIRD -P ARTY B ILLING P ROJECT Specific project tasks include: Integrating sites into a Project Stakeholder Advisory Group for quarterly meetings Conducting specialized credentialing and contracting between sites and Medicaid MCOs Conducting RCM/EMR regional meetings and site- specific trainings Conducting a formal project evaluation, to include a cost-benefit analysis Conducting reviews of successful insurance claims submissions and revenue generation
J OIN O UR P ROJECT ! For more information, and to join the IPHA HIV Third-Party Billing Project, please contact: Kevin Atchason, IPHA, 217-522-5687 or katchason@ipha.com IPHA’s billing e -mail address that public health organizations can use to ask ANY third- party billing-related questions: insurancebilling@ipha.com
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