Ready for ACA?: Assessment of third-party billing and reimbursement for Texas HIV, STD, TB, Viral Hepatitis and reproductive health services
Methods: An online survey provided an environmental scan of Texas HIV, TB, STD, and viral hepatitis providers’ current billing practices, funding sources, anticipated barriers to third-party billing, and awareness of client financial and insurance status. One hundred and seven respondents completed the survey between December 6, 2012 and March 15, 2013. Respondents represented a range of organization types and sizes.
Results: Seventy four percent of organizations collected client financial information and 77% collected insurance information. About half were billing third-party payers. Slightly less than half used electronic health records. Government grants, including Ryan White Care Act Grants, comprised the largest proportion of funding for most organizations. Many organizations served large proportions of individuals whose income fell below the federal poverty level and would not be eligible for subsidies in the insurance marketplace, nor for Medicaid in Texas.
Conclusions: It will be crucial to maintain HIV, STDs, TB, and viral hepatitis services in the face of a changing funding landscape. These results reveal diverse billing and reimbursement capacities across organizations. Hospital-affiliated specialty clinics and community health centers appeared to be the best prepared to adapt to the emerging healthcare environment. Local health departments and community-based organizations seemed at greatest risk of eliminating services if public funding declines.
Learning Areas:Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Public health or related public policy
Discuss an assessment of the funding sources, billing practices, and anticipated needs of HIV, STD, viral hepatitis and tuberculosis providers in the face of a changing health care policies and funding.
Keyword(s): Affordable Care Act, Funding/Financing
Qualified on the content I am responsible for because: I have been working with the Texas Department of State Health Services HIV/STD Unit and safety net organizations around the state on issues of sustainability and capacity building in a changing healthcare funding environment. I was involved in the development and implementation of the survey data being presented as well as subsequent technical assistance efforts.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.