Office of Resource Access and Partnership (ORAP) Case Study
How can we determine which sites that bill for third party resources are compliant with all established third party control policies and procedures? How can we verify sites are up-to-date with data entry and billing for third party resources in a timely manner? If sites are having challenges collecting third party resources, what are those challenges? These are just some of the issues faced by the Office of Resource Access and Partnership related to billing for third party resources. Since third party resources make up a significant portion of the IHS budget, it was essential to find a way to track these issues and more importantly, develop a solution that could ultimately improve the third party billing collection process.
Partnering with the Indian Health Performance Evaluation System (IHPES), the ORAP developed a web-based "Third Party Internal Controls Policy Self-Assessment System". This is an application that serves as a tool for the ORAP and Office of the Director to monitor compliance with Third Party Internal Control policies and procedures. The application tracks eleven (11) specific areas relating to third party revenue generation: 1) facility specific procedures; 2) IT systems; 3) Patient Registration/Check in; 4) Benefits Coordination; 5) Coding/Data Entry; 6) Billing; 7) Posting; 8) Account Review/Follow Up; 9) Collections/Deposits; 10) Finance; 11) CEO Responsibilities. Using statistics generated from the self-assessment tool, ORAP can then target specific areas that may need improvement in the billing process as well as identify other target areas for improvement such as training and IT systems.
The self-assessment tool is now the "standard" for all IHS programs to ensure each site billing for third party resources is compliant with all established polices and procedures. This is also the primary tool used by the ORAP to demonstrate IHS’s commitment to ensuring each site is in compliance with all new and established polices and procedures as determined by the Office of Inspector General (OIG) or other Federal guidelines relating to third party revenue generation. In the near future, the tool will be expanded to include the ability to enter "corrective action plans" (CAP) to ensure sites are in full compliance with all IHS standards, policies and procedures regarding third party reimbursement activities.