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Tuberculosis ServicesTo Bill or Not to Bill?

Presented by: Lisa ParkJune 1, 2015

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Charging (or not) for TB Services• How to charge for Tuberculosis services is covered

in the VDH Eligibility Guidance Document (EGD) under Non-chargeable Services

• Section Header – Services provided at no charge to the patient

• Health districts may charge patients’ private health insurance

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NO CHARGENo charge to Individuals for assessment, exam or

testing if they are:

• suspected of having or known to have TB disease • contacts of individuals with known active TB• individuals with a newly positive TB skin test

No charge for DOT or DOPT

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CHARGEABLEAssessment, examination or testing is chargeable

when done for other purposes

For example, when needed for• employment• school• admission to nursing facility• admission to group home

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Chargeable-Active TB or LTBI• Treatment of active disease or LTBI may be

charged to the patient or their health insurer

• Districts can charge a flat rate or sliding scale for drugs and diagnostic tests

• Health director determines flat or sliding for all TB tx-must be applied the same for all individuals

• Patients cannot be charged for anything paid for by the Division of Disease Prevention (DDP)

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Revenue vs. Public Health• Patients with suspected or confirmed TB (active

disease or infection) cannot be denied treatment for non-payment

• Patients having difficulty paying should be assessed for a Waiver of Charges as detailed in the EGD

• Eligibility determinations should be carefully reviewed to ensure the household size/income has been appropriately identified

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Revenue vs. Public Health, cont’d• Avoid creating potential barriers to care

• Focus should be on encouraging and facilitating treatment

• Refrain from worst case scenario cost discussions

• Discuss payment plan options at the beginning of treatment before an account becomes past due

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QUESTIONS?