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- 3rd Party Reimbursement
HCET Home > On-line Training > Money Matters > 5. Alternative Sources of Payment: 3rd Party Reimbursement
5. Alternative Sources of Payment: 3rd Party Reimbursement
Not for profit is a
tax status; is it NOT a business plan
- You will probably find that XIX does NOT cover the full cost of services
- Must be sure your costs are covered by a combination of grants, patient fees and third party reimbursement. This helps you achieve your mission and/or expand your services
- It is important to do a needs assessment of your area
- This is based on the TPR training developed at HRSA, the Health Resources and Services Administration of the US Department of Health and Human Services
- Patient Base – Who do you serve?
- Services Offered – Relative to payers
- Service Volume – How many units and what level?
- Their payment rates
- What services each plan covers, and
- Under what circumstances
- Hire a nurse practitioner rather than an RN because the NP is billable
- Are you providing case management but calling it “Care Coordination?” Semantics matter – case management may be billable
- Charging/billing for services that were preciously provided at no charge
- Provide more services to more people
- Improve the quality and accessibility of care
- Upgrade/expand facilities and services
- Enhance the program’s overall financial stability
- Eliminate services that lose money
