The Indian Health Service (IHS), an agency in the

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Indian Health Service: Updated Policies and Procedures and Increased Oversight Needed for Billings and Collections from Private Insurers

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By Kay L. Daly (au); Kathleen M. King (au)
Year: 2009
Pages: 20
Binding Paperback

Product Code: 1437927106

Description

The Indian Health Service (IHS), an agency in the Dept. of Health and Human Services (HHS), provides health care services to Am. Indians and Alaskan Natives. For FY 2009, Congress appropriated approx. $3.6 billion for health care services to be made available through IHS. IHS headquarters oversees 12 area offices that cover 161 service units in 35 states. The Indian Health Care Improvement Act of 1976, as amended, authorizes IHS to collect reimbursement for services provided at IHS facilities from third-party insurers, including Medicare, the fed. health insurance program for elderly and disabled individuals; Medicaid, a joint fed. and state health financing program for certain low-income families and individuals; and private health insurers. IHS is allowed to retain funds collected from these insurers without a corresponding offset against its appropriations, so that all revenue collected by a facility remains with that facility, supplementing its appropriations. For FY 2008, IHS reported that it collected about $795 million from all third-party insurers, of which about $94 million, or 12%, was collected from private insurers. The remaining 88% was collected from the Medicare and Medicaid programs. This report examined several areas related to IHS's billings and collections activities. Specifically, it reviewed IHS's policies and procedures for writing off amounts owed to the agency by private insurers, internal control procedures related to billing and collection, and the amounts and reasons for denied claims and claims written off as uncollectible by IHS. Because IHS was unable to provide much of the information requested on the amounts of denied and adjusted claims and amounts written off for more than 6 months after requests for these data, this report examines (1) the design of IHS's policies and procedures for billing and collecting revenue from private insurers including write-offs of uncollectible claims, and (2) the adequacy of IHS headquarters' monitoring of area office and service unit compliance with policies and procedures for the billing and collection of revenue from private insurers. Figures.

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