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Options for HIV Billing Options for HIV Third-Party Billing Services Antonio O. Arias, MBA, CHBME Provider Advocate NCG Medical, Inc. November 30, 2018 Options for Third-Party Billing of HIV Services Executive Summary Medical billing is a complicated task for many medical practices, but for some Local Health Departments (LHD), Community-Based Organizations (CBO), and other Healthcare Providers (HCP) specializing in HIV service provision, the complicated nature of medical billing has impeded the formation of any billing capacity. Changing this trend will allow these organizations to address ways to increase their revenue and their stability, so that they can continue improving public health through the services they provide. Third-party billing refers to billing Medicare, Medicaid, and private insurance for medical services provided, as opposed to first-party billing which refers to charging patients. There are many challenging components to the medical billing process that may deter organizations from prioritizing billing. However, third-party billing is important when considering alternative and dependable revenue streams. Given the complexity of the medical billing process, some organizations choose to contract with external companies for third-party billing services. This choice is known as medical billing outsourcing. The decision to outsource begins by understanding and analyzing the risks, costs and differences between handling medical billing in- house versus outsourcing. The process of creating an in-house medical billing department includes: Creating a fee schedule which sets the price for the services provided Hiring billing staff to manage the billing process Credentialing and contracting in order to work with insurance companies, Medicare, and Medicaid Finding a clearinghouse to check claims for errors and forward information to insurance payers Completing billing activities such as coding, claims submission, and denial management The process of outsourcing medical billing includes: Creating a fee schedule, possibly with the help or review of an outsourcing partner Hiring a medical billing outsourcing company which will most likely charge a percentage of monthly revenue as payment Overall, in-house billing departments offer HIV service providers greater control over the process and patient satisfaction, the ability to limit the sharing of confidential information, freedom from possible hidden costs, the ability to predict fixed billing costs, and a return on investment if a provider has already invested in in-house medical billing. Yet, establishing and 2 maintaining an in-house medical billing operation can be prohibitive for organizations providing HIV services with little experience or resources available to manage the process. The benefits of outsourcing include reduced errors, enhanced consistency, maintaining focus on patient care instead of billing, steadier and more predictable cash flow, ensured billing compliance, liability avoidance, and the benefit of relationships the outsourcing company has already established. Outsourcing partners can also provide helpful performance reports, and all of these factors often actually lead to higher revenue for providers from outsourcing than from in-house billing. Outsourcing has moved away from being an “all or nothing” affair due to technology that has become available in the last few years allowing organizations to take a hybrid approach to revenue cycle outsourcing. The best outsourced medical billing firms design their offerings with an understanding that medical providers face unique constraints depending on the services they offer. HIV services providers can also choose to outsource as little or as much as they would like. This leaves them with the flexibility to focus on their strengths while utilizing the services of an outsourcing partner in the aspects of the process where they need the most help. In an environment where many organizations are receiving none of the revenue they could potentially receive from third-party payers for the services they are already providing, outsourcing may offer an option for them to bill those payers without having to go through the process of setting up an in-house medical billing department from scratch. For those that have some capacity for third- party billing already, outsourcing could still help fill in the gaps, so they can bring in more revenue overall. This white paper was funded by a grant from the Illinois Department of Public Health. 3 Introduction Medical billing is a complicated task for many medical practices, but for some Local Health Departments (LHD), Community-Based Organizations (CBO), and other Healthcare Providers (HCP), the complicated nature of medical billing has impeded the formation of any billing capacity. Changing this trend will allow these organizations to address ways to increase their revenue and their stability, so that they can continue improving public health through the services they provide. As these organizations begin the process of developing billing capacity, it is important to consider all available paths to achieving that goal. In-house medical billing departments are a more conventional option, whereby provider staff manages billing operations on site. Yet, LHDs, CBOs, and HCPs can also consider outsourcing, either all or part, of their billing operations. Providers can weigh the advantages and disadvantages of in-house billing, partially outsourced billing, and fully outsourced billing to choose the option that makes the most sense for them. The focus of this paper is on the operational decision-making involved with addressing whether to outsource the billing function for LHDs and related organizations. In particular, the paper focuses specifically on billing related to the provision of HIV services for these organizations. HIV Third-Party Billing Human immunodeficiency virus (HIV) weakens a person’s immune system by destroying important cells that fight disease and infection.1 HIV can be controlled with proper medical care, but no effective cure exists. Some groups of people are disproportionately likely to contract HIV, spurring movement towards greater accessibility of routine HIV screening and HIV prevention services. LHDs, CBOs, and HCPs may provide one or more of the following HIV/AIDS services:2 Screening/evaluation: Clients may complete a questionnaire on demographic and risk information prior to testing Testing: Sites may offer serum HIV antigen/antibody testing, Fingerstick HIV antibody/antigen testing, or both. Diagnosis: Early diagnosis is important for receiving the greatest benefit from drug therapy. Counseling: Regardless of their diagnosis, clients who are tested for HIV may also receive counseling to reduce their risk of acquiring or transmitting the virus Counseling may also be provided to partners of clients.3 Referral: With diagnosis, providers often offer the client information about medical, mental health, and social support services, as well as partner referral services 1 CDC. 2018. “HIV Basics.” Last modified July 23, 2018. https://www.cdc.gov/hiv/basics/ 2 Mookencherry, Shefali. 2017. “Credentialing, Contracting, Coding and Billing for Public Health HIV Services.” December 15, 2017. https://ipha.com/content/uploads/HIV%20cred-contr-cod- blg%20Webinar%2012-15-17.pdf 3 Wisconsin Department of Health Services. 2018. “HIV Counseling, Testing, and Referral Program.” Last modified September 28, 2018. https://www.dhs.wisconsin.gov/aids-hiv/ctr.htm 4 Treatment: There is no cure for HIV, but anti-retroviral therapy can slow the progress and complications of the disease, and prevent secondary infections. Some organizations also provide preventive HIV drugs to reduce the risk of HIV infection. Medical tests for most conditions are primarily conducted in a clinical setting that bills insurance companies for the services they provide on a regular basis. HIV testing and other services are unique in that they can often take place at Local Health Departments (LHD), Community-Based Organizations (CBO), and other Healthcare Providers (HCP) unequipped to bill public or private payers and health plans.4 The range of settings providing HIV testing and other HIV services makes it possible to reach a broader set of people who are at risk, but these services are unsustainable without a dependable funding source. In addition to supporting existing services, there is still progress to be made in terms of expanding routine HIV screening and HIV prevention services to fill service gaps in high incidence geographic areas. These areas experience late diagnoses, unsuppressed viral loads, and higher rates of HIV transmission. Expanding services to address these issues will not be possible without local providers developing the capacity for consistent funding.5 One revenue source that many LHDs, CBOs, and HCPs have yet to take advantage of is third- party billing, including the provision of services related to HIV. Third-party billing refers to billing Medicare, Medicaid, and private insurance for medical services provided, as opposed to first-party billing which refers to charging patients. The National Alliance of State and Territorial AIDS Directors stated in its 2016 HIV Testing and Billing Report that less than half of LHDs who deliver HIV testing services have capabilities for third-party billing. Even less reported that they require health department-supported providers to bill third party payers. The HIV Testing and Billing Report also discovered that different venues have different
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