Topic: Billing & Reimbursement
Collection of tools on third-party billing and reimbursement and calculating the cost of care.
Guidelines and Manuals
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HRSA HIV/AIDS BureauDecember 2016
HRSA’s HIV/AIDS Bureau guidance and requrements for grantees of the Ryan White HIV/AIDS Program on such topics as eligibility, allowable use of funds, and clarifications of legislative requirements.
Webinars and Training
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CRE TA Center, National Center for Innovation in HIV CareMay 2016
Strategies for getting ready to bill and the systems you need in place to get started.
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HealthHIVMay 2016
HRSA/HAB Fiscal Monitoring Standards require Ryan White HIV/AIDS Program recipients and subrecipients to have policies and procedures regarding the imposition and assessment of client charges.
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HealthHIVMay 2016
Training resources on enhancing billing systems to maximize revenues, covering CPT and ICD codes in the HIV/AIDS care context.
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CRE TA CenterApril 2016
Tips for negotiating contracts with insurers.
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CRE TA CenterFebruary 2016
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HealthHIVJune 2015
This webinar explains eligibility determination (ED) and strategies to manage ED.
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HRSA HIV/AIDS BureauMarch 2015
Presentation on sliding fee scale and cap of out-of-pocket charges.
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CRE TA CenterJanuary 2015
This webinar provided an introduction to the National Technical Assistance (TA) Center for Contracting and Reimbursement Expansion with Medicaid and Marketplace Insurance Plans (CRE), a new HAB-funded cooperative agreement.
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National Academy for State Health PolicyJune 2013
Requirements and resources to build capacity to conduct third party billing and reimbursement.
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Positive Outcomes and The George Washington UniversityMay 2013
Webcast (and slides) on what HIV medical clinics should consider in assessing readiness and preparing for or expanding participation in health insurance markets.
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HealthHIVJanuary 2011
Training on meeting federal and state fiscal requirements, fiscal compliance assessment, implementing Ryan White payer of last resort policies, applying Federal Poverty Level guidelines to assess sliding fees, and financial sustainability.
Tools and Job Aids
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CRE TA CenterMay 2017
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HealthHIVMarch 2016
Assessment of Medicaid coverage of HIV/AIDS prevention, screening, and care services (e.g., testing, counseling, PrEP, condoms) in ten selected states.
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CRE TA CenterMarch 2016
This tool is designed for staff that administer or manage the delivery of RWHAP-funded core medical services to help ensure their organization is able to adequately bill and be reimbursed for providing vital health care services to their clients.
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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.
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CRE TA CenterMarch 2015
This Roadmap can help you navigate resources that deal with contracting, billing and enrollment with Medicaid and Marketplace Insurance Plans.
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SAMHSASeptember 2014
Worksheets to cross-compare CPT billing and diagnostic codes for integrated health services.
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TARGET CenterOctober 2013
Collection 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.
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National Academy for State Health PolicyJune 2013
Steps for safety net providers to take in preparing for third-party reimbursement.
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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.
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Feldesman Tucker Leifer Fidell LLPNovember 2012
Overview of managed care models, reimbursement methods, and insights on contracting with MCOs.
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University of Wisconsin-MadisonJune 2011
Guide to help substance abuse treatment agencies increase their capacity to bill health insurance and Medicaid plans for their services.
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HealthHIVJuly 2007
Resources to build agency skills in financial management (e.g., federal grant requirements, budgeting, fundraising, accounting principles).
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CDC, HRSAJanuary 2002
Sample managed care purchasing specifications related to primary and secondary prevention and medical management of HIV/AIDS.
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HRSA HIV/AIDS Bureau
Workbooks to help Ryan White planning bodies and other entities self-assess their effectiveness. Each SAM is designed for use by a small ad hoc group.
Reports and Best Practices
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NASTADNovember 2016
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
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HealthHIVMarch 2016
Assessment of Medicaid coverage of HIV/AIDS prevention (testing, screening, condoms, PrEP) and care coverage in 10 select states.
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The AIDS InstituteApril 2015
Review of how major health care payers cover HIV testing and other prevention services under ACA preventive health provisions.
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CARDEAJuly 2013
Case study on how Oregon’s state lab set up Medicaid and other third-party billing to diversify revenue.
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NASTADApril 2013
Resource bank of best practices in third party billing and reimbursement, compiled from health departments, safety net providers, and others.
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NASTADApril 2013
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.
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MosaicaAugust 2012
Considerations for safety net providers in preparing for implementation of the Affordable Care Act (e.g., third-party billing, restructuring operations).
Websites
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SAMHSA-HRSA Center for Integrated Health SolutionsJanuary 2016
Resources on integrating primary care with behavioral health services to better address mental health and substance use needs.