Federally Qualified Health Center (FQHC) medical billing is an essential and complex part of the revenue cycle, requiring diligent attention to the details of documentation, coding, and regulations. Taking the necessary steps to optimize the billing process ultimately optimizes reimbursement for an FQHC. Experts in FQHC coding and billing understand the intricate nature of the process, but following these important tactics can give your organization the leverage it needs to maximize reimbursement and capitalize on quality.
Understand Your FQHC Reimbursement Cycle and Submit Claims in a Timely Manner
Reimbursement is a critical component of the revenue cycle for a healthcare organization and can be complex for an FQHC. Organizations must understand the many factors that can affect reimbursement and how timely submission of claims supports timely and accurate reimbursement. Focusing on the starting point of the reimbursement cycle will ensure that accurate information is captured from registration to coding and documentation so that claims are error-free and ready for submission. The cycle is a simple process, but details matter:
- Registration – capturing accurate patient demographics and insurance information when scheduling an appointment
- Insurance and eligibility checks – verifying that insurance is active and determining if a patient is eligible for scheduled services
- Documentation and coding – capturing accurate CPT and diagnosis codes and documenting services as outlined specifically for FQHCs
- Documentation must be completed within a short timeframe to avoid issues with timely filing.
- Charges – entering accurate billing charges for services rendered
- Claim review – finalizing claims and checking for errors
- Timely submission – guaranteeing timely review by the insurance payer with a quick turnaround of payment
- Patient collections – following up with patients on balances for timely payments
The reimbursement cycle is the life cycle of payments from the first penny to the final dollar, and FQHCs must follow the process to ensure that claims are submitted in a timely manner. Reimbursement can result in partial or full denials if one piece of the cycle is missing or information is not captured correctly. Understanding how to capture each piece of the reimbursement cycle puzzle is critical for the success of the FQHC.
Leverage Technology to Streamline Your FQHC Billing and Reimbursement Process
FQHC reimbursements depend on a complete cycle of gathering accurate information and submitting claims. Technology has a significant role in the reimbursement process, as the majority of healthcare organizations are using electronic health record (EHR) systems and electronic billing to streamline processes and create efficiency.
Technology is not isolated to EHR systems and electronic billing. The demands of the industry require healthcare organizations to focus on reporting and analysis that focuses on key metrics of quality and finances to determine the viability of a facility.
FQHCs are not immune to this type of reporting. They can benefit from the technology that provides this high level of analysis. Many EHR systems have built-in practice management software that focuses on the key aspects of the revenue cycle and can report on the quality of claims that are processed by the facility.
From paper charts to mobile applications, technology has progressed through decades of evolution to create the most efficient processes to optimize reimbursement. With the best that technology can offer, FQHCs can optimize their capabilities within the EHR from registration to final payment.
Consider Outsourcing Your Medical Billing Services
Medical billing for FQHCs requires a dedicated team of experts who understand the full cycle of reimbursement for these specialized facilities. Medical billing is complex, but billing for public health facilities requires a keen understanding of the constantly changing regulations and the need to comply with CMS requirements.
Outsourcing medical billing for an FQHC does not remove any control for FQHCs. In fact, outsourcing is a step towards creating more success for the organization, as the burden of medical billing is removed from the staff, giving the FQHC the freedom it needs to focus on patient care. Outsourcing can include everything from registration to reporting and receivables management to follow-up on claim denials. Detailed reporting is always a must with the reimbursement cycle, and when you choose your company, make certain you choose a company that can deliver what you need based on your organization’s goals.
Questions about FQHC Medical Billing Services? Contact us at Coronis Health Today!
FQHC medical billing services are unique, if not completely different from the typical medical billing office or private practice. The nuances of billing for FQHCs require the attention of experts who understand the changing environment of government regulations, and the importance of complying with current coding and billing procedures. Reports and analytics, along with revenue cycle and denial management, drive the changes that are evident in the healthcare industry. Outsourcing could be your key to making positive changes for your FQHC. If you want to see how to make these changes, contact Coronis Health to request your free financial checkup. Let Coronis Health handle the billing, and you can focus on the most important part of your FQHCs job – the patients. Call Today!