W HY B ILL T HIRD -P ARTY P AYERS FOR HIV AND O THER P REVENTIVE H - - PowerPoint PPT Presentation

THE IPHA HIV THIRD-PARTY BILLING PROJECT

Jeffery Erdman Illinois Public Health Association Billing Stakeholder Advisory Group Meeting August 26, 2019

WHY BILL THIRD-PARTY PAYERS FOR HIV

AND OTHER PREVENTIVE HEALTH

SERVICES?

 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

• r to expand services to other vulnerable

populations (i.e., clients eligible for PrEP).

IPHA EXPERIENCE WITH THIRD-PARTY BILLING FOR PUBLIC HEALTH SERVICES

 Through a five-year CDC

grant, IPHA assisted nearly 85 LHDs, serving rural and urban counties throughout Illinois, with capacity- building to bill for immunizations and other preventive health services to patients covered by Medicaid, Medicare and the major insurance carriers in Illinois:

 Aetna  BlueCross BlueShield of IL  Cigna  Coventry  Harmony  Health Alliance  HealthLink  HFN  Humana  IlliniCare  Meridian  Molina  United Healthcare

IPHA EXPERIENCE WITH THIRD-PARTY BILLING FOR PUBLIC HEALTH SERVICES

 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 THIRD-PARTY BILLING PROJECT

 From 2018-2020, IPHA and CDP are partnering on the HIV Billing Grant

to:

• Credential and contract 5 local health departments (LHDs), community-based
• rganizations (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

• rganizations (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 THIRD-PARTY BILLING PROJECT

 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

JOIN OUR PROJECT!

 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