Final Report of an Assessment of Private Insurance Coverage and Medicare/Medicaid Reimbursement among Indians Eligible for Health Care Provided by the Indian Health Service

摘要

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with MACRO Systems, Inc. to forecast the reimbursements that IHS could reasonably expect to obtain over the next several fiscal years. The study was designed to: provide estimates of potential IHS reimbursements from Medicaid, Medicare and private health insurance; identify factors that may impact upon IHS third-party reimbursements. The estimates generated showed that IHS can increase substantially the amounts of third-party reimbursements over the next several fiscal years, especially from Medicaid and Medicare. However, the rate of increase will be more gradual than previously expected. Several factors were found which may potentially affect the IHS third-party billing and collection effort. Some are specific to the IHS organization itself, which others involve the nature and availability of the third-party payment programs and processes. All of these combine to create a constantly changing third-party payment environment, influencing billings and collections. Factors which may have contributed to the variation in IHS historical billings and collection performance, some of which may continue to have an influence, are presented and analyzed.