Strategize about Billing
Assess Billing Options
Be sure you know how each completed test will be billed. Look at which programs and payers cover testing. This information could cause you to adjust your test choices, depending on what can be reimbursed.
Our biggest billing challenge was in our dental clinic, where we lacked a medical staff member who could bill for the test. What might have been a great opportunity to support sustainability presented hurdles we couldn’t overcome during the project period. See the Quick Clinic Story below for more.
Integrate Billing into Workflow & EHR
Look at the best places to incorporate billing in your clinical workflows and electronic health record system. The fewer extra steps you add, the less of an impact HIV testing will have, and the more likely patients will be to be tested. Build templates for each different test you offer and include relevant CPT codes, and train your staff on proper use of the new templates and any additional billing codes.
Stock Up on Supplies
Stocking of rapid tests can be challenging, if only because they need to be purchased in advance of their use. Purchasing a bulk supply of 100 tests can cost more than $1000, so when choosing to use rapid tests, it’s important to be realistic about their effect on cash flow. Building financial sustainability into your testing program is crucial to its long-term success.
For example, in 2016 California’s Medicaid SPA family planning program (Family PACT) began reimbursing for 4th GEN HIV labs. This opened up a sustainable path for offering rapid HIV labs at all visits that qualified under the SPA’s family planning services
A Quick Clinic Story: Dental Clinic Testing
|Implementing testing at our Dental site proved challenging. Dental Clinic leadership was excited to start HIV testing, so we began conversations with staff by teaching them about the oral health needs specific to people living with HIV/AIDS and agreed regular HIV testing would benefit their patients.
Their clinic workflows required rapid oral testing, but we struggled to develop an HIV screening process that fit seamlessly with their clinic procedures. In part, this was due to space limitations and the challenge of providing HIPAA-compliant test results in an open dental operatory environment. We brainstormed about laminated sheets to offer negative results, and potentially offering preliminary positive results in a private office space. However, in the FQHC environment, every square foot that can be used to see patients typically is. There was simply no empty and available space.
Nevertheless, we moved forward, trusting in our ability to eventually iron it out. Next, we tackled the workflow. The AIDS Education and Training Center recommends utilizing Clinical Laboratory Improvement Amendments (CLIA) waivers by having each dental technician administer the test at the beginning of the visit and having the dentist present results at the end of the visit. Since 3rd GEN oral HIV tests are CLIA-waived, we added the Dental Clinic to our CLIA certificate and began preparing our dental lab for HIV testing implementation. One additional hurdle we faced but never had time to overcome was having to use two different electronic health records for each visit.
Billing challenges were our final hurdle. In the California FQHC environment, most of our patient visits are billed through the state’s Medicaid program. At the time of our project implementation, HIV testing was only billable under a medical visit; testing under dental visits couldn’t be billed. This created a gap in operational costs since our dental clinic lacked a medical staff person who could bill for testing. We worked directly with the State Office of AIDS and consulted with teaching dental clinics in New York to problem solve. Unfortunately, we were unable to successfully fill this gap. We hope our groundwork lays the foundation for others to take this work further.
So unfortunately, regardless of staff support, HIV testing was never implemented at our dental site because without a way to bill for the test or clinician’s time, long-term sustainability was impossible.