Supporting HIV care through education and innovation

Obtaining Third-Party Reimbursements: Issues for a Safety-Net Clinic to Consider

Obtaining Third-Party Reimbursements: Issues for a Safety-Net Clinic to Consider

August 1, 2012
Author:
Emily Gantz McKay EGM Consulting LLC
Mosaica

Description

Considerations for safety net providers contemplating the establishment of third party billing and reimbursement for Medicaid, Medicare, and private insurance, as a result of the Affordable Care Act (ACA) and expansion of the third party payer environment.  A series of assessment questions are outlined, including, for example:

  • Financial Needs and Expectations (e.g., costs that need to be reimbursed, current patient profile and the likelihood they would be covered under Medicaid and private insurance and thus represent a source of third party payment).
  • Types of Third Party Reimbursements (e.g., which payers, in which jurisdictions).
  • Required Relationships (e.g., intent to contract directly with health plans, how many, establishment of relationships with service provider networks that, in turn, have contractual relationships to build upon).
  • Recordkeeping and BIlling Capacity (current financial recordkeeping system, electronic meiccal record system).

 

Add a Comment

Log in or register to post comments