STD Clinic Billing: Who's Doing It? Part 1

Background: The ACA increases the number of Americans with health insurance coverage.  Simultaneously, funding for safety net clinics is unsteady; federal and state agencies want to ensure safety net services are utilized as payer of last resort. Safety net programs are expected to diversify revenue by expanding third-party billing of both public and private payers. The STD-related Reproductive Health Training and Technical Assistance Centers (STD RH TTAC) are funded regionally to provide training and technical assistance to support the implementation of billing systems for clinics providing publicly-funded STD services. The STD RH TTACs conducted a national coordinated needs assessment to find out how many STD-certified 340B clinics bill Medicaid and other third party payers and understand the barriers to billing.  

Methods: A web-based needs assessment was sent from ten regional TTACs to STD-certified 340B clinics and agencies. Data from each region was compiled into a national data set and analyzed in SAS 9.1.  JSI tested differences between group medians using the Wilcoxon Rank Sum test. For categorical variables, JSI calculated proportions for the entire sample and for specific groups of interest (stratified analysis). JSI tested the association using a chi-square test. A p-value of less than 0.05 was considered indicative of a significant difference.

Results: Less than one half (45%) of clinics were billing both Medicaid and third-party payers; 30%  were billing Medicaid only, and one quarter (25%) were not billing Medicaid or other third-party payers at all. The clinics that were not billing were smaller; more likely to provide STD services only; and more likely to be Health Department STD clinics compared to those that were billing.

Conclusions: There were over 1,000 clinics not billing private third-party payers. The barriers  identified through the assessment include:  prohibitive policies, confidentiality concerns, lack of staffing resources, and lack of infrastructure.