- Community Health Programming
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Through its Payment System Reform initiative, NCUIH provides technical assistance and training to address structural challenges introduced by the implementation of Health Care Reform, as well as helping to improve intervention programs. UIHPs can be the frontline to help reduce the alarming disparities of Indian Country, specifically in urban settings. National Healthy People 2020 goals (which aim to reduce health disparities) can be achieved through the targeted implementation of health care reform, which can improve program revenues (e.g., through increased opportunities for third-party billing) and ensure a focus on quality of care (e.g., through PCMH accreditation).
In order to acquire the benefits provided by the Affordable Care Act, clinics and health programs across the US are accommodating a renewed payment system that incorporates the Third Party Billing System, as well as other structural components to keep their financial structure up and running.
In recent years, NCUIH has operated the Payment Systems Reform Project through its analyst contractor, Medical Business Advocates LLC (MBA), which accounts for highly specialized technical expertise on Medicare, Medicaid, and private insurance. MBA also possesses very specific knowledge on the use of the Indian Health Service’s Resource and Patients Management System. Additionally, MBA possesses specific knowledge about UIHPs and a high level of cultural competency.
NCUIH’s Payment Systems Reform is comprised of two main activities:
NCUIH has already engaged the Accreditation Association for Ambulatory Health Care (AAAHC) in a national webinar providing UIHPs an introduction to the accreditation process. During 2015-2016, NCUIH will have a new Community of Learning focused on accreditation for the UIHPs. It is expected that the majority will be interested in AAAHC as this is the primary national accrediting body that UIHPs have utilized. However, NCUIH is committed to partnering with other accreditation organizations to meet the needs of the UIHPs, including Commission on Accreditation of Rehabilitation Facilities (CARF), Improving Patient Care (IPC) or other state and national accrediting bodies. Many UIHPs have the desire to become accredited in order to bring more value to their programs and ease the process of gaining higher CMS reimbursements for their services.
Revenue, Third-Party Billing:
NCUIH has been providing technical support to UIHPs to increase revenue through training on third-party billing (TPB) and reimbursements through an external consultant/ sub-contractor that is knowledgeable and has experience in Billing and Coding. TPB training is necessary to continue the great accomplishments that have been gained by educating financial staff and billers on the tools and tips to more efficiently receive reimbursements. Using this training, two programs have been able to bring billing in-house with newly implemented EHR systems and many programs were able to identify new areas where billing was not collected. The new implementation of the prospective Payment System for Medicare will require more thorough understanding of the new codes and requirements for programs to bill as FQHCs.