Tribal Health Solutions Group (THSG) has interviewed all Tribal Nations participating in the pilot program for the USDA Grant.
The final eight are:
- Eastern Band of Cherokee Indians
- Mississippi Band of Choctaw Indians
- Jena Band of Choctaw Indians
- Poarch Band of Creek Indians
- Houlton Band of Maliseet Indians
- Passamaquoddy Tribe – Indian Township
- Seneca Nation of Indians
Most of the sites identified issues with checking eligibility. The difficulty is that they have to log into several different websites to check eligibility for everyone. We have come up with a solution to use a clearinghouse to check eligibility on one site. We will also be able to create a file of patients to be seen on a particular day and submit them in mass. The only ones that registration will have to check on are the ones that come back as no coverage. Registration can then contact the patient to inform them that they must bring in the current insurance information.
Another of the issues identified is tracking rejections and denials. Again, having to log into several different websites to check on rejections and denials is VERY time consuming. Using a clearinghouse will put all the claims in one place for all payers making it much more efficient to correct issues.
Six clearinghouses were interviewed and the final two were selected based on several criteria. We measured the six on ease of use, reporting capabilities and of course, price. All the sites will be able to utilize the functions of the clearinghouse at a much reduced price due to the volume of eligibility inquiries, claim submissions and remittance retrieval. The clearinghouse contracts are in the hands of the attorney, and as soon as we get the green light, we will sign one of the contracts and we will be off and running.
Implementation of the clearinghouse can take up to 90 days due to payer turn-arounds. We will be the first source for training and support of these new products. Once the pilot sites are implemented, we will be adding other sites that may want to take advantage of the clearinghouse functions at a much reduced cost.
Resource Patient Management System (RPMS) training was very HIGH on the list. Either there has been a lot of turnover and knowledge was not transferred or as updates were loaded and features added, no training was provided. We are getting as much information as possible to pass on to all of our Tribal Nations.
Purchase Referred Care (PRC) is another issue. There seems to be a disconnect in the process. We are researching the process with IHS to identify a solution. Check back with us in a few months on this one.
Coding is an issue that is not quickly fixed. IHS provides American Association of Professional Coders (AAPC) training for certification, but the classes are only provided once a year. Coding inpatient facilities requires more investigation, so we are investigating coding software solutions to increase coding accuracy and decrease time invested. We will keep you updated.
The visits to the pilot sites were very revealing as to what needs to occur to maximize reimbursements. We are sure as we work with the pilot sites that we will be able to assist in many different ways!
USET is also submitting another grant proposal that will allow THSG to continue working with all Tribal Nations to streamline the revenue cycle process.