Billing for Federally Qualified Health Centers (FQHCs) requires a thorough knowledge of the unique nature and structure of these types of centers and organizations, their challenges and limitations, and a fundamental understanding of Medicare and state Medicaid billing.
Outsourcing FQHC medical billing services may be the best decision you could ever make for your center. Medical billing services focus on providing more than just billing and coding expertise. Billing professionals also understand the reporting requirements for FQHCs and prioritize the full picture of revenue cycle management to ensure that profits increase, days in A/R decrease, claims are clean, and your FQHC is operating at its highest potential.
Below, we explore why outsourcing billing services will benefit your FQHC.
The Challenges of FQHC Medical Billing
The complexity of billing for FQHCs goes beyond the typical billing for commercial insurance. Because these centers are funded by the federal government and grants, specific coding is required to ensure that all services are documented accurately and that billing practices are compliant with the rules and guidelines set forth by the Centers for Medicare and Medicaid (CMS) and the Health Resources and Services Administration (HRSA).
FQHC billing is distinctly unique from billing for commercial insurance, as many centers operate with Medicaid, which reimburses at a much lower rate. Changes in CMS requirements also complicate the FQHC billing and coding process (e.g., the billing requirements for telehealth related to the COVID-19 pandemic).
FQHC medical billing is tricky compared to standard billing claims. One small error can result in a large number of claim denials. Since Medicare and Medicaid reimburse FQHCs, billers must submit claims with the correct CPT, HCPCS, and T-codes to avoid denials.
The Benefits of Outsourcing FQHC Medical Billing Services
There are many advantages to outsourcing your FQHC billing services:
- Lower costs – outsourcing billing services reduces monthly salaries, payroll taxes, and benefits to full-time employees. You also save time and resources on recruiting, training, and managing staff.
- Fewer errors – mistakes such as incorrect codes and patient data, duplicate billing, and authorization errors can be costly. Outsourcing medical billing allows you to partner with billing specialists with many years of industry experience, and their expertise guarantees that every claim undergoes a thorough process using the best billing practices.
- Improved cash flow – denied claims and payment delays negatively impact your revenue. Outsourcing enables a more efficient workflow and timely submission of bills, resulting in increased revenue for your FQHC.
- Improved efficiency – outsourcing medical billing services streamlines your operations and workflow. With more automated tasks, your staff can focus more on their critical administrative functions and operational areas, resulting in enhanced productivity.
- Improved patient care – by allowing trained and experienced billers to handle all billing and coding requirements, you can focus on patient care.
- Compliance – Keeping up with the ever-changing rules and regulations in healthcare can be a source of concern for many facilities. Outsourcing eliminates the headache of tracking these updates. Your billing company constantly adapts to new policies, applies new rules, and follows updated guidelines, giving your facility one less thing to worry about.
How to Choose the Right FQHC Medical Billing Company
Here’s a look at some criteria to consider when selecting an FQHC medical billing company that you will partner with:
Expertise in FQHC Billing
Different facilities and specialties have unique billing and coding challenges. Billing companies specializing in FQHC management have a better understanding of your center’s requirements for documentation, coding, compliance, and more.
Support Throughout the Entire Billing Cycle
You need a company that will be there throughout the entire revenue cycle management – from before a patient’s appointment to the final reimbursement for claims. The company you choose must excel at every stage of revenue cycle management, including claim submissions, follow-up, payment processing, patient invoices, and accounts receivable follow-up.
Security
Partnering with a medical billing company means being able to trust them with sensitive financial and patient data. You must make sure that the company you select is going to handle all this data securely. Ask about the company’s security system and the processes they use to make sure your information is protected. They’ll also stay up-to-date on regulations and rules, so your FQHC billing services stay current with changing conditions.
Excellent Customer Support
Fast, high-quality customer support is crucial throughout your partnership. You want to ensure that your medical billing company offers quality customer support and helpful resources that enable you to achieve peace of mind, as well as success.
Transparency
Will your staff have all access to records that are transferred into the medical billing system? The right partner will give you real-time access to any information that you are looking to review.
How to Get the Most Out of Your Relationship with an FQHC Medical Billing Partner
The best way to benefit from your relationship with a medical billing partner is by asking the right questions and clearly communicating your needs. Examples of pertinent questions to ask are:
- What services do they provide?
- What training does their staff receive?
- Can they help optimize your practice management software?
- Do they offer solutions to improve medical coding?
- How quickly will they be able to begin processing claims?
- Will monthly financial reports be provided?
Ultimately, what you want to achieve through your relationship includes:
- Increased revenue
- Decreased days in AR
- Reduced denials
- Higher average encounter rates
- Accelerated and steady cash flow
- Increased clean claim rates
- Lower processing costs per claim
What to Expect When Outsourcing FQHC Medical Billing
When you outsource your FQHC medical billing services, you gain a partner that will not only take care of billing but will also work to improve every part of your revenue cycle. Their team of experts looks below the surface, identifying and helping you fix the workflow issues that are negatively affecting your reimbursements, including the front desk, provider medical coding, practice management (PM) system optimization, and extensive denials management. By going beyond the billing department, they can identify the source of cash leaks and work with your team to stop them at the source.
Companies like Coronis Health give you access to cutting-edge technology and the best software solutions designed to streamline workflow, track claim status, and improve your first-pass rate.
With your billing partner, you can expect improvement in the following areas:
- Front desk concerns, including eligibility
- Provider coding accuracy
- EDI challenges and systems interfacing
- Claim scrubbing and submissions
- Clearinghouse communications
- Denial reporting and prevention
- Charge entry and payment posting
- Long-term revenue cycle growth strategies
Questions About Outsourcing Your FQHC Medical Billing? Contact Us at Coronis Health Today.
Coronis Health’s medical billing and revenue cycle services are designed specifically for FQHCs and CHCs to optimize their revenue cycle and create increased cash flow by identifying and capturing missed revenue.
We truly admire the outstanding work that FQHCs deliver. We recognize the tremendous need for your services and have made it our mission to assist centers like yours in the achievement of their financial goals. Do you need to reassess your FQHC billing process? To learn more about how Coronis Health can help meet your specific needs and allow you to get back to treating patients, contact us to request your free financial checkup.