Topic: Billing & Reimbursement
Collection of tools on third-party billing and reimbursement and calculating the cost of care.
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Webinars and Training
CRE TA Center, National Center for Innovation in HIV CareMay 2016
Review of strategies for agencies to undertake to get ready to bill for their services in order to enhance their financial sustainability, including: how to assess feasibility for billing, various billing models, and actions for organizations to take to put billing systems into place.
Training resources on enhancing billing systems to maximize revenues, covering CPT and ICD codes in the HIV/AIDS care context.
This webinar explains eligibility determination (ED) and strategies to manage ED.
Tools and Job Aids
Assessment of Medicaid coverage of HIV/AIDS prevention, screening, and care services (e.g., testing, counseling, PrEP, condoms) in ten selected states.
CRE TA CenterMarch 2016
Tool for conducting a cost analysis: the process of determining the unit cost or the average cost of providing specific services over a defined period of time in order to use this information to bill and secure reimbursement for services provided.
CRE TA CenterSeptember 2015
Tool for assessing your organization’s strengths and gaps in areas that are of importance to insurers and that support maximizing revenue realized from contracting activities.
CRE TA CenterMarch 2015
This Roadmap can help you navigate resources that deal with contracting, billing and enrollment with Medicaid and Marketplace Insurance Plans.
TARGET CenterOctober 2013Collection of resources on compliance programs, which are an essential component of agency operations and entail mechanisms to ensure, for example, appropriate handling of payments, claims, and audits.
West County Health CentersMarch 2013
Form for clients explaining the maximum annual amount of costs patients will incur (annual payment cap) for services they receive from Ryan White providers. Once this payment cap is reached in a given year, Ryan White providers will not charge any more for the rest of the year.
Reports and Best Practices
Fact sheet to explain policies and procedures for ADAPs to follow to ensure that Ryan White funds are used as the payer of last resort, including for Medicaid. D
Assessment of Medicaid coverage of HIV/AIDS prevention (testing, screening, condoms, PrEP) and care coverage in 10 select states.
Summary of survey findings on third party billing practices of state health departments and their local providers, with an action step chart for health departments in building the billing capacity of agencies.