“Recent Trends in Third-Party Billing at Urban Indian Organizations: A Focus on Medicaid, Telehealth, and Pandemic Response.”
This report provides an overview of billing methods and payment methodologies that Urban Indian Organizations (UIOs) use for third-party reimbursement, with a special focus on Medicaid. The report includes analyses of UIO Medicaid claims from the Transformed Medicaid Statistical Information System (T-MSIS). The report uses data from calendar year 2018, which was the most current T-MSIS data available.
- UIOs provided services to 86,335 Medicaid Beneficiaries.
- 19% of UIO Medicaid Beneficiaries were categorized as “American Indian or Alaska Native” within the Race/Ethnicity variable.
- UIOs received $108 million in Medicaid reimbursement.
- The rate of claims denial for beneficiaries categorized as “American Indian or Alaska Native” within the Race/Ethnicity variable was (3.39%), which was lower than the average rate of 6.2% for all beneficiaries.
- The rate at which UIO claims were denied was correlated with a state’s policy environment. In states participating in the Affordable Care Act (ACA) Medicaid Expansion Program, 4.64% of claims made by a UIO were recorded as denied in T-MSIS. In Non-Expansion states,11.39% of UIO claims were denied.
A recording of a CMS Webinar presentation on the report is available on YouTube here.
A copy of the Webinar slideshow is available from CMS here.