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The Quadruple Aim
Quadruple Aim

A Conceptual Framework

Improving the U.S. health care system requires four aims: improving the experience of care, improving the health of populations, reducing per capita costs and improving care team well-being. HITEQ Center resources seek to provide content and direction aligned with the goals of the Quadruple Aim

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Overview

Through the data validation process, valuable information is gained that can then be used to improve performance around patient care or quality of care metrics.  Improving quality performance may take the form of improving data collection processes, better identifying patients who need additional interventions, or decreasing missed opportunities to provide patients appropriate interventions, among other possibilities. This section includes guidance on leveraging Health IT to improve quality performance including change packages for recommended approaches related to various quality of care measures.

Improving Performance Resources
Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and Other HIV Prevention Strategies: Billing and Coding Guide
HITEQ Center
/ Categories: Priority Topics, Ending the HIV Epidemic, HIV, PrEP

Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and Other HIV Prevention Strategies: Billing and Coding Guide

Developed by NASTAD, updated in 2023

Health departments and other medical providers are billing Medicaid, Medicare, and private insurers for services related to HIV prevention. The counseling services needed for the treatment and discussion of lab tests are intensive. This guide describes the procedure and diagnosis codes that are accepted by public and private insurance, along with specific requirements for some Current Procedural Terminology (CPT®) billing codes. It also describes some of the challenges in obtaining reimbursement for testing, counseling, linkage to care, and adherence services.

The goal of this guide is to provide up-to-date information and best practices for coding, billing, and denial resolution for PrEP and PEP services. Health department staff are encouraged to share this resource with grantees, community partners, and other health care providers billing for HIV prevention services.

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Tags: GuideBillingcodingHIVPrEPEnding the HIV EpidemicHIV screeningHIV prevention

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Acknowledgements

This resource collection was compiled by the HITEQ Center staff with guidance from HITEQ Advisory Committee members and collaborators of the HITEQ Center.