National Council of Urban Indian Health
1 Massachusetts Avenue NW
Suite 800-D
Washington, DC 20001
Phone: 202.544.0344
FACT SHEET
Payment Systems Reform Initiative
BACKGROUND
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:
- 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
- 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 our research team at research@ncuih.org
Accreditation:
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.