Sustaining HIV/AIDS and Viral Hepatitis Services: Leveraging Third-Party Reimbursement

By Liisa M. Randall, Consultant and Amy Killelea, Senior Manager, Health Care Access, NASTAD

Medical Bills by http://www.flickr.com/photos/attercop311/With federal and state funding for HIV/AIDS and viral hepatitis services increasingly constrained, it is essential that health departments explore alternative sources of support to ensure the sustainability of vital services. Full implementation of the Affordable Care Act (ACA) provides new opportunities for health departments and implementing partners to leverage resources made available through third-party reimbursement. Please visit NASTAD’s health reform website for resources on what the ACA means for HIV/AIDS and viral hepatitis programs and services, and how health departments are preparing for reform.

Assessing Health Departments’ Capacity for Third-Party Billing and Reimbursement

Until now, health departments have relied largely on grant funding to support comprehensive HIV/AIDS and viral hepatitis prevention and care programming. Because of this historical reliance, many health department HIV/AIDS and viral hepatitis programs have relatively limited knowledge of and experience with third-party billing and reimbursement. To inform plans for technical assistance to support health departments in increasing their third-party billing and reimbursement capacity (and that of their contracted providers), NASTAD assessed current health department practice regarding third-party billing and reimbursement as well as the legal and regulatory challenges faced by health departments in implementing third-party billing. The results of the assessment are contained in an Issue Brief: Health Departments and Capacity for Third-Party Billing and Reimbursement: A Status Report and Resources for Capacity Building.

NASTAD’s assessment made it clear that health department capacity for participating in third-party billing is currently limited. Survey findings indicated that only 11 of 29 health departments that provide services directly to clients are engaged in any sort of billing of third-party payers. An encouraging finding is that many of the agencies that health departments support to provide HIV/AIDS and viral hepatitis services, especially community health clinics and other providers of medical services, have the capacity to bill Medicaid and other insurers for health services. However, most health departments do not require their contractors and grantees to bill for those services which are reimbursable by third-party payers, such as HIV and HCV screening services.  

How Health Departments Can Build Capacity for Third-Party Billing and Reimbursement

There are several concrete steps that health departments can take now:

  1. Assess the capacity of service providers in your jurisdiction to participate in third-party billing and reimbursement. A sample tool is available for download here.
  2. Talk to your health immunization or family planning programs. These programs have likely already implemented third-party billing and can provide you with valuable information and lessons learned. You may also be able to leverage existing billing capacity within your health department.
  3. Collaborate with your public health laboratory to implement billing for testing for HIV and viral hepatitis.
  4. Require health department contractors and grantees that have the capacity to do so to seek third-party reimbursement for services which are reimbursable.
  5. Consult with your state Medicaid program to ensure or negotiate coverage of vital preventive services.

To ensure sustainable services, health departments cannot afford to wait any longer to develop their capacity and that of local HIV/AIDS and viral hepatitis service providers to participate in third-party billing and reimbursement. Some resources that can help you get started are available here.

For additional information about this report or about NASTAD’s activities around billing and reimbursement, please contact Amy Killelea, Senior Manager, Health Care Access or Liisa Randall, NASTAD Consultant.

We want to hear from you! Is your health department implementing third-party billing? Tell us about your experience and share resources that have helped you by leaving a comment below.