Published February 3, 2018
Additional funds are due to third-party billing collections, will help cover elective orthopedic referrals
TAHLEQUAH — More contract health surgeries and MRIs will be covered for Cherokee Nation citizens utilizing the tribe’s health system after a record $9.4 million increase in third-party billing collections the first quarter of 2018, compared to the first quarter of 2017.
The tribe received $36.1 million in third-party collections for the first quarter of fiscal year 2018, compared to $26.7 million in collections the first quarter of fiscal year 2017.
A portion of those additional funds will cover more contract health referrals, which have grown from 87 referrals per day in 2004 to 412 referrals per day in 2017. With referrals increasing nearly five fold, the tribe has continued to approve contract health funds for patients with life-threatening needs to see specialists like oncologists, cardiologists and for pediatric orthopedics or adult fractures.
Without funding keeping pace with the exponential growth in referrals, patients with elective orthopedic needs such as shoulder, leg or arm pain that required MRIs or surgeries needed to cover out-of-pocket expenses after Medicare, Medicaid or private health insurance paid their shares. Additional funds will pick up a larger portion of those cases.
“The Cherokee Nation, through the Cherokee Nation Health Services, diligently works every day to improve health care delivery to our citizens and patients,” Cherokee Nation Principal Chief Bill John Baker said. “Recently, we have increased capabilities because of a spike in third-party billing success. That’s due to aggressive efforts to enroll patients in the Affordable Care Act, embracing new digital record technology and strategic changes in the physician salary structure that reward our doctors for the quality and quantity of patients they see. Quality is up across the board at Cherokee Nation Health Services, and we have more funds dedicated to contract health needs.”
Charles Grim, interim executive director of Cherokee Nation Health Services, said the funding increase is due to improved management of patient records thanks to a new electronic health record system, a pay increase for doctors that measures quality performance and efficiency, and successful ongoing education and outreach to enroll patients into Affordable Care Act marketplace insurance plans, SoonerCare and Medicare.
“We hope patients understand that Cherokee Nation Health Services strives to meet the needs of all tribal citizens, but one of the biggest components of meeting those needs is managing costs,” Grim said. “Making sure we optimize the way we collect from third party insurers means serving even more patients with contract health referrals.”
The first quarter of fiscal year 2018 includes third-party collections from the period between Oct. 1, 2017, and Dec. 31, 2017. The first quarter of fiscal year 2017 includes the period of Oct. 1, 2016, through Dec. 31, 2016.
Under Chief Baker’s administration, more revenue from gaming proceeds is earmarked for contract health than ever before. The new outpatient health center opening on the campus of W.W. Hastings Hospital in 2019 will be the largest tribal health facility in the country. It will house more specialists like cardiologists and have two MRI machines on site.
Neither of those specialties are currently offered on the W.W. Hastings campus, so contract health dollars are used every time a tribal citizen is referred to either specialty.
“We are moving in a positive direction, and in 2019 when the new facility at the W.W. Hastings campus opens, it will offer even more specialized care options. That’s essential to fulfill the growing demands of our patients,” Chief Baker said.
Patients can get more information about additional coverage options by contacting their patient benefits coordinators at any Cherokee Nation health facility or by visiting www.CherokeeCare.com.
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This BBSNews article originally appeared on Native News Online.