Reimbursement

A group of interdepended strategies impact the percentage of SBHC visits reimbursed by health insurance: consent, insurance status verification, coding, billing, and collections.

Example from the SBHC Field

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Case Example: Increasing SBHC Enrollment and Visits in Rural New York

A group of rural SBHCs from Bassett Health in New York increased both enrollment and visits across their centers by marketing their services at open houses and kindergarten registration. They solicited help from the schools’ nurses to improve consent rates, insurance status verification, and student referrals. They also obtained the schools’ approval to include SBHC consent forms and insurance verification in school enrollment packages.

Watch their story here:

Frequently Asked Questions

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1. How can my SBHC program improve consent and insurance status verification?

  • Obtain consent forms and student insurance information when the student first registers for the clinic. Verify this information at each visit and make updates as indicated.
  • Photocopy patients’ insurance cards or verify insurance status online.
  • Track renewal dates for patients’ insurance coverage. Prompt and support the patients to renew their coverage if needed.
  • Facilitate health insurance enrollment for uninsured students and families onsite or by referral to an outreach and enrollment specialist.

2. What do you recommend we do to improve our business practices around coding, billing, and collections?

  • Conduct in-service training for SBHC staff on CPT and ICD coding, Explanation of Benefits (EOBs), and billing/collection procedures.
  • Code all SBHC services provided and submit all claims promptly to payers to maximize insurance reimbursement.
  • Offer group visits and allow for one-on-one time between the patients and care provider (i.e., asthma, diabetes, healthy lifestyles, psycho-educational groups). Utilize group visit codes and submit for reimbursement.
  • Analyze any denied claims and resubmit corrected claims to payers.
  • Establish a separate SBHC cost center and post all expenses and revenue to it.
  • Report SBHC utilization data, expenses, and revenue from visits to SBHC staff monthly, and strategize how to decrease expenses and increase revenue.

Telehealth Ideas

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