Third-party billing for public health STD services: A summary of coordinated needs assessment results

The ACA increases the number of Americans with health insurance coverage.  Funding for safety net clinics is uncertain; federal and state agencies want to ensure safety net services are utilized for the un- and under-insured. Safety net programs are expected to diversify revenue by expanding billing of both public and private payers, while maintaining access to services. The STD-related Reproductive Health Training and Technical Assistance Centers (STD RH TTAC) are funded regionally to provide training and technical assistance to support implementation of billing systems for clinics providing publicly-funded STD services. The STD RH TTACs conducted a coordinated national needs assessment to find out how many STD-certified 340B clinics bill Medicaid and other third-party payers and to understand the barriers to billing.  

An assessment was sent from ten regional TTACs to STD-certified 340B clinics and agencies with a response rate of 72%. Data from each region was compiled into a national data set and analyzed in SAS 9.1.

Results were compiled from 333 responses representing 1,935 individual clinics. Less than one half (45%) of clinics were billing both Medicaid and third-party payers; 30% of clinics were billing Medicaid only, and one quarter (25%) of clinics were not billing either. Clinics that were not billing were smaller; more likely to provide STD services only; and more likely to be Health Department STD clinics.

There were over 1,000 clinics not billing third-party payers. The barriers  identified through the assessment include:  policies, confidentiality concerns, lack of staffing resources, and lack of infrastructure resources.