Supporting Third Party Billing in Public Health Laboratories

Background: Public health laboratories (PHLs) have been severely impacted by the 2008 recession and subsequent budget reductions at the state and local levels. With the impact of health reform, PHLs are looking to Medicaid and other third-party billing to sustain services. Based on a coordinated national needs assessment conducted by the STD-related Reproductive Health Training and Technical Assistance Centers (STDRHTTACs), 38% of PHL respondents reported that they do not bill for STD services, in spite of the fact that 62% reported billing for other services. More than one-quarter of respondents indicated that they think they need to bill for STD services, but do not know where to start; more than half indicated that they had initiated billing or had limited billing capacity, but need technical assistance (TA).

Methods: Cardea/STDRHTTAC in Regions VI, IX and X and JSI Research & Training Institute (JSI)/STDRHTTAC in Regions VII and VIII are developing TA resources to support state and local PHLs in building capacity to bill.

Results: Cardea hosted a webinar featuring the Oregon State Public Health Laboratory's (OSPHL's) experience with billing Medicaid and subsequently developed a case study to provide more detail on OSPHL's billing implementation process, improvements and challenges, and lessons learned. JSI is developing an online decision tool to support PHLs who are at various stages in the billing and reimbursement practice continuum. The tool provides an introduction to, step by-step instructions, and resources for billing, coding, and reimbursement for PHLs that are either not currently billing or not billing proficiently.

Conclusions: In some areas, STD programs have moved away from partnerships with PHLs because of lack of capacity to bill for STD services. PHLs need TA at the national, regional, state and local levels to build capacity to bill Medicaid and other third party payers and remain a vital partner to public health programs.