Payment System Reform

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:

  1. Program Support: guided work on improving practices for ICD-10 implementation and third-party billing accuracy for UIHP billing/ coding and executive staff through a Payment Systems Reform Community of Learning.
    • Rationale/purpose: new models of health care delivery payment, as well as new ICD codes for billing/ coding will be instituted beginning in the Fall of 2015 and UIHPs will need to be prepared for these changes in order to reduce impact on financial reimbursement delivery. Revenue streams and financial data reporting are heavily dependent on full and accurate implementation of third party- billing processes, which require UIHP staff training and technical assistance.
    • Activities: support on ICD-10-CM, GPRA, PPS Review, A/R Management implementation through conference calls and WebEx sessions
  2. Technical Representation: work with federal partner workgroups regarding health care reform to provide technical assistance and representation for UIHPs.
    • Rationale/purpose: Urban representation at meetings pertaining to CMS initiatives and health reform partnerships with federal agencies are necessary to advance the needs of urbans and to remain up to date on new initiatives that could affect the urban AI/AN community.
    • Activities (Stepping Stones): Support and provide input to partners on health reform, participation at meetings/ calls, disseminate information to membership and constituencies

If you are a NCUIH Member Organization and would like to join the PSR initiative activities, please contact Kimberly Fowler, Ph.D- Technical Assistance and Research Director- at kfowler(at)ncuih.org

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