Overcoming Resistance to Billing for STD-Related Services

Background: 

The Knox County Health Department (KCHD) had systems and infrastructure in place to begin billing for STD services. Resistance to initiating billing for STD services persisted among some health department leadership and frontline staff, concerned that charging clients would negatively impact access to care, equity, and clinic volume. To address this, the Region IV STD-related Reproductive Health Training and Technical Assistance Center (CAI) provided technical assistance (TA) to facilitate implementation of billing and fee collection for STD-related services.

Methods: 

CAI engaged senior clinical leadership to clarify challenges and develop the TA approach. Three 2-hour sessions were delivered: 1) didactic session with KCHD leadership and frontline staff from STD, HIV and FP clinics intended to build a rationale for billing, and share examples of other health departments’ experience implementing billing; 2) skills-building session with front-line clinic staff (including scripting and role-playing) on how to discuss billing for services with clients, assess need for confidential services, and obtain insurance information or utilize a sliding fee scale, 3) interactive training with leadership to support development of strategies for leading and managing changes associated with billing implementation. Next steps were identified and carried out by KCHD’s clinical leadership team.

Results: 

CAI’s TA supported the KCHD clinical leadership team in initiating billing. Billing roll out activities included dissemination of communications plans providing information about STD billing processes to staff, clients and community referral partners. Messaging addressed patient confidentiality and ensured provision of services despite clients’ ability to pay. Billing for STD services was successfully implemented on October 1.

Conclusions: 

When implementing billing and reimbursement systems and policies amid concerns about reduced client volume, confidentiality and access to services, targeted TA, including skill building, case examples, and implementation of internal and external communication plans, can facilitate the transition to billing for STD-related services in public health settings.