Consider
Billing
Develop Billing Systems
Manage Revenue Cycle
Initiate Contract Process
Enhance Coding Capacity
Request
TA
Consider Billing
This module 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 support you identify the first steps. 
indicates recommended tool
Affordable Care Act
| Tool description | Format |
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| ACA…It’s Here! A simplified one-page description of how the Affordable Care Act’s provisions may impact STD clinics. – Region I STD TAC, 2014 |
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| NCSD Case Studies Providing real world examples of partnerships and business models for building relationships with third-party payers, these case studies highlight the experiences of STD programs and clinics currently billing third-party payers for STD-related services, or planning to implement a third-party billing practice. – National Coalition of STD Directors |
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| Provider Marketplace Toolkit This ACA HRSA toolkit includes resources and materials that clinicians and health care administrators can use to educate patients about their new health coverage options, how insurance works, and the benefits of having insurance. – HRSA |
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| ACA Basics for Title X To help family planning providers obtain a better understanding of the ACA, this frequently updated resource page includes links to relevant websites, videos, factsheets, articles, info-graphics, and more. – Family Planning National Training Centers |
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| Essential Community Providers FAQs This document provides frequently asked questions regarding essential community providers. – Centers for Medicare & Medicaid Services, 2013 |
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| Enrollment and Marketplace Resources Federal list for enrollment and ACA-related insurance marketplace resources. – Centers for Medicare & Medicaid Services, 2014 |
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| Commonly Used Acronyms and Terms A reference list of commonly used terms and acronyms related to billing, insurance and electronic medical/health records. – Region I STD TAC, 2014 |
Initial Decisions
| Tool description | Format |
|---|---|
| How to Initiate Third-Party Billing: A Case Study of Hartford STD Clinic *NEW! This case study demonstrates how the Hartford STD Clinic reduced its dependence on diminishing federal and state funding by establishing third-party billing. – STD TAC, 2016 |
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| Shifting to Third-Party Billing Practices: Policy Context and Case Studies An introduction to what STD Service providers need to consider as they approach the decisions surrounding third-party billing. – National Coalition of STD Directors (NCSD), 2012 |
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| Is it Time to Start Billing? Questions & Considerations This tool offers discussion prompts, considerations and a SWOT analysis grid designed to guide decision-making teams in determining if they are ready to start billing. – Region I STD TAC, 2014 |
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| Considering a Partnership? *NEW! Read about six types of partnerships that can support billing efforts and then follow the suggestions for planning a partnership with another organization. – STD TAC, 2016 |
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| Sample Payer Mix Survey – For Clinics Not Billing A basic, short survey to determine insurance mix of clients and a corresponding tracking sheet for clinics that are currently not billing. [Customizable for clinic needs] – Region I STD TAC, 2014 |
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| Sample Payer Mix Survey – Clinics with Limited Billing A basic, short survey to determine insurance mix of clients and a corresponding tracking sheet for clinics that are currently engaged in limited billing. [Customizable for clinic needs] – Region I STD TAC, 2014 |
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| In-House or Outsourced Billing *Updated! A decision-making tool that describes the pros, cons and considerations to explore before making the decision to use in-house or outsourced billing services. – STD TAC, 2016 |
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| Outsourced Billing Company: Considerations and Tips *NEW! This tool provides a list of considerations and questions when considering outsourced billing companies, as well as tips for negotiating a contract with them. – Region I STD TAC, 2015 |
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| Billing Clearinghouses 101 A description of billing clearinghouses including the process, benefits, items to consider, and steps to acquire clearinghouse billing services. – Region I STD TAC, 2014 |
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| First-Party Billing Implementation & Considerations *Updated! This document outlines steps and considerations for clinics that may not be ready for third-party billing but want to start collecting a fee or billing patients (first-party billing). – STD TAC, 2016 |
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| Key Questions from Case Studies Excerpted from the NCSD case studies, a comprehensive list of the key questions to consider when trying to make decisions about billing. – National Coalition of STD Directors (NCSD), 2012 |
Legal/Policy Issues
| Tool description | Format |
|---|---|
| Setting the Stage: Policy and Funding Landscape Looking at the current funding landscape, the impact of ACA, and the regulatory challenges to creating a third-party billing system, this resource provides sample legislation, regulations, and approaches taken to remedy these restrictions. – National Coalition of STD Directors |
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| HIPAA Fact Sheet A one page fact sheet outlining the Health Insurance Portability and Accountability Act (HIPAA) requirements and links to additional related resources. – Region I STD TAC, 2014 |
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| Law Atlas: Insurance Billing for Sensitive Health Services This report provides information about the laws and regulations that impede or facilitate STD prevention efforts with particular attention to barriers to billing private insurance for services. – Robert Wood Johnson Foundation: LawAtlas |
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| Confidentiality for Individuals Insured as Dependents: A Review of State Laws and Policies A state-by-state review of legal requirements related to confidentiality in private insurance for individuals insured as dependents. – Guttmacher Institute, 2012 |
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| EOB Policy Brief: Protecting Adolescent Confidentiality Under Health Care Reform Summary report of how confidential sexual health services may be revealed to third parties through the Explanation of Benefits (EOBs) with potential strategies for addressing this policy problem. – UCSF Philip R. Lee Institute for Health Policy Studies, et al., 2014 |
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| Minors’ Access to STI Services This document, for youth and parent use, lists state-by-state regulations for minors’ consent for HIV/STI services. – Guttmacher Institute, 2014 |
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| Billing and Confidential Health Services *NEW! On this website, you will find the white paper, Confidentiality, Third-Party Billing, & the Health Insurance Claims Process: Implications for Title X, describing why and how the insurance claims process can disclose private information and a policy guide with recommendations. You can also search the website for promising practices that can be adapted to health centers to identify patients in need of private payment. – National Family Planning & Reproductive Health Association, 2015 |
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| Implementing the Affordable Care Act for Adolescent and Young Adults: Practical Considerations An interactive webinar which examines practical topics pertinent to adolescents and young adults in light of ACA, including confidentiality. – HRSA, 2013 |
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