STD Billing and Reimbursement Toolkit

With the passage of the Patient Protection and Affordable Care Act (ACA), participation in third-party billing is increasingly important. Many previously uninsured Americans will have access to health insurance coverage. Traditional safety net providers, such as STD clinics, which have historically provided free or low-cost services through public funding, are facing fiscal challenges through a decrease in public health STD funds. Implementing or expanding third-party billing is a way to diversify revenue streams, ensure access to care, and potentially expand services to populations who need them the most.

This toolkit is designed to help publicly-funded STD clinics and public health laboratories make decisions about whether to bill, and how to develop billing systems, manage revenue cycles, initiate contracts, and enhance coding capacity. Modules are organized by topic and may be used sequentially or individually. *Acknowledgements

Go to Module 1: Before You Begin Go to Module 1: Before You Begin

Consider Billing

Outlines reasons to consider initiating third-party billing, and provides the necessary resources to help you decide if billing is right for your clinic/lab. If you are ready to start billing, the tools in this module will help you identify and support the first steps.

Go to Module 2: Develop Billing Systems Go to Module 2: Develop Billing Systems

Develop billing systems

Covers all aspects related to developing a billing system. Provides sample policies, procedures, and forms that are easily customizable for your clinic/lab, as well as, a section to help you meet your Health Information Technology (HIT) needs.

Go to Module 3: Manage the revenue cycle Go to Module 3: Manage the revenue cycle

Manage revenue cycle

Offers e-learning resources to build your clinic/lab’s capacity in revenue cycle management. Includes tools to assist with the implementation of practical everyday functions of billing and a section that outlines special
considerations for labs.

Go to Module 4: Initiate the contract process Go to Module 4: Initiate the contract process

Initiate contract process

Provides lessons learned, tips and FAQs on contracting with third-party payers, and includes customizable timelines and checklists. Also contains tools detailing steps for provider credentialing and a sample contract.

Go to Module 5: Coding Go to Module 5: Coding

Enhance coding capacity

Features introductory e-learning resources on coding for reproductive/sexual health services. Also offers coding job aids, a customizable encounter form, information about preventive services codes and a transition to ICD-10 section.

Go to Module 6: Request TA Go to Module 6: Request TA

Request TA

STD programs, clinics, and state public health labs may request Technical Assistance (TA) for STD billing and reimbursement training or TA. TA provision will be prioritized by severity of need, geographic distribution, and availability of funding.

Disclaimer:The tools provided in this toolkit are samples and may not comply with your agency's policies and protocols, and/or state and local laws and regulations; all tools should be verified and/or modified to be compliant before use.