Billing for Clinical Services
Local health departments are facing shrinking federal, state and local budgets. Although public health has traditionally been free, the cost of providing preventive and clinical services such as immunization as well as HIV, STI, and TB testing has been growing for health departments. LHDs play an integral role in the changing landscape of the Affordable Care Act and will continue to provide services for their community.
Even with expanded insurance coverage, gaps will remain and LHDs will need to develop a way to provide services to insured patients as well as those left uninsured. In order for LHDs to be able to provide preventive and clinical services regardless of insurance status, they may need to develop the capacity to bill third party payers. LHDs should be compensated by billing Medicare, Medicaid and private insurance companies for immunization, HIV, STI, TB testing and care, and other clinical services.
This site should serve as a guide and a resource for LHDs in building capacity to bill third party payers for clinical services. Whether your LHD is just starting the process to be able to bill or already has contracts with private insurance companies, NACCHO’s Billing for Clinical Services Toolkit has resources, templates, and manuals to help with your process.
In the Spotlight
NACCHO was funded by the Centers for Disease Control and Prevention (CDC) to create a toolkit with resources, templates, and tools for local health departments to use and develop capacity to bill third party payers for immunization, STD, TB and HIV services. More than 200 resources have currently been collected from state billing guides, the Centers for Medicare and Medicaid Services, state health departments, local health departments, insurance companies, and vendors of products such as electronic medical records and billing clearinghouses.
For more information on how to use NACCHO's Billing for Clinical Toolkit, click here. More »
Billing Training Opportunities
JSI Billing Webinar Series
Transitioning to Billing Part 1: Assessing your Capacity to Successfully Manage Revenue as a Key Element of Agency Sustainability, December 10, 2013 (1:00 PM EDT).
As agencies shift from relying on grants to billing payers for their services, they must assess and analyze their capacity to manage revenue through billing third-party payers. This webinar will introduce protocol, procedures, and infrastructure that agencies must consider prior to seeking reimbursement through third-party payers, as well as the cultural shifts that must occur to ensure success. Click here to register for Part 1.
Transitioning to Billing Part 2: Best Practices for Successful Reimbursement - Implementing Effective Revenue Cycle Management Practices as a Key Element of Agency Sustainability, December 17, 2013 (1:00 PM EDT).
Claims submission, billing, and collections are often considered the key components to receiving reimbursement; however, revenue cycle management is much more than submitting a bill. This webinar will build upon Transitioning to Billing 1, and provide specific details and strategies necessary to effectively receive reimbursement from third-party payers through managing revenue. Click here to register for Part 2.
Becoming an In-Network Provider: The Health Department Perspective
The public health system is transforming due to the Patient Protection and Affordable Care Act and the decline in federal and state discretionary funds. Public health departments have started to seek alternative sources of revenue to continue providing services in their community. Many health departments are exploring billing for clinical services provided and are trying to become a contracted in-network provider with health plans.
NACCHO hosted a webinar titled “Becoming an In-Network Provider: The Health Department Perspective” where speakers from Mississippi, New York, and North Dakota shared their contracting experiences. The recording from this webinar is available here and you can find the slides here. Answers to the Q and A section will be available soon. More »
Billing News and Journal Articles
Peer Networking Opportunities
The Improving Reimbursement for Health Department Clinics Community of Practice is an online collaboration tool hosted by phConnect.org that allows members to access expertise and share experiences, success stories, tools, and ways of addressing barriers in planning and implementing billing projects.
The community is open to any program and/or organization interested in billing, and the following documents will explain how to join and how to use the community.
Billing Meetings and Presentations
CDC Billing Stakeholder Meeting, August 26, 2013
NACCHO Annual 2013
- Local Health Department Strategies to Address the Affordable Care Act and Implications for Immunization
- This was a facilitated session on the implications of the Affordable Care Act (ACA) on immunization programs. You can view the presentation here.
- Building Revenue in Local Health Departments by Billing for Clinical Services
- This was a panel discussion that addressed the challenges and successes of local health departments in billing for clinical services such as immunization, maternal, child, and adolescent health, and STD/HIV. If you attended NACCHO Annual, you have access to this session for six months. Log in and listen to the session here.
NVAC September 2011
Local Health Departments and the Affordable Care Act
What's the Role of Local Health Departments in Implementing the Affordable Care Act?
- The ABCs of the ACA. Alliance for Health Reform. October 2013.
- Low Income Consumers' Lack of Financial Literacy Could Impede Use of ACA Coverage, Subsidies. Health Affairs Blog. September 2013.
- NACCHO'S Webinar on The Affordable Care Act: What You Need To Know Slides and Recording, August 2013
- Recently Michelle Chuk Zamperetti, MPH, Senior Advisor and Chief of Public Health Infrastructure and Systems at NACCHO, spoke with New Public Health about the role of local health departments in the Affordable Care Act. You can read this conversation here.
- At NACCHO Annual 2013, CDC Director Dr. Tom Frieden, discussed the implementation of the Affordable Care Act, and the future of public health under sequestration.
- Paying for Population Health: A View of the Opportunity and Challenges in Health Care Reform, IOM, September 2013
- Moving Forward On Medicaid Reform: Shared Savings In Medicaid, And How To Do It, Health Affairs Blog, September 2013
- Health Reform Implementation Dominates HA Blog July Top Ten, Health Affairs Blog, August 12, 2013
- ACA Timeline: Key Dates for Providers and Patients, Medscape, August 23, 2013
- The Affordable Care Act (ACA) requires Qualified Health Plans (Insurance plans) to contract with some Essential Community Providers (Safety Net Providers) – providers with experience caring for medically underserved populations. This is an important thing to remind health plans as you reach out to begin to contract with them.
- Kaiser Family Foundation recently released Zooming in on Health Reform, a tool that provides a better understanding of the potential impact the ACA has on Medicaid and the uninsured on the local level.
If you need more information about The Affordable Care Act and the changes on the way, you can visit NACCHO's Health Reform page.
LHDs in the News