FQHC

At Coronis Health, we use our global resources, tech innovation, and scalability to help FQHCs maximize revenue through data analysis in which we create customized workflows and KPIs.

Our knowledgeable staff focuses on collections and ways to improve the process to increase your revenue while ensuring regulatory requirements are being met. Because of our approach, you and your staff can focus on improving the quality of patients’ lives by providing a focused personalized care plan. Contact Coronis Health to find out how we can help FQHCs maximize revenue for your practice.

What is FQHC Medical Billing

FQHC medical billing is one of your business’s cornerstones. It is a complex, time-consuming task requiring extensive knowledge of billing and coding practices that will help facilitate optimal reimbursements. Medical billing covers the process of submitting and following up on claims with insurance providers in order to receive timely payment for services rendered by healthcare providers. In other words, medical billing will translate a particular healthcare service into a billing claim. A medical biller will follow the claim to ensure the facility receives reimbursement for the work performed. A skilled and knowledgeable biller can significantly help optimize revenue performance for any facility. 

What is FQHC Revenue Cycle Management?

An FQHC facility must ensure an efficient and effective revenue cycle process. The revenue cycle consists of all the administrative functions, clinical processes, and software applications that contribute to and manage the registration, filing, charging, billing, payment, and collection tasks associated with a patient encounter. The FQHC’s life cycle begins when the patient is scheduled and ends when the account is paid or denied.

What are the Unique Challenges FQHC’s Face?

For decades, FQHCs have provided a safety net for individuals in need of healthcare services. It has taken a prominent role in the system, providing primary care as well as multi-specialty services such as obstetrics/gynecology, behavioral health, chronic diseases management, vision, and preventative care to medically underserved populations. And because of the wide array of services it provides, as well as its unique approach to healthcare, FQHCs will encounter specific challenges including:

• Sliding fees – FQHCS must operate a sliding fee system for the uninsured. To determine if patients are eligible to receive discounted services, they must undergo a financial assessment based on the federal poverty guidelines. Regardless of how discount eligibility is determined, FQHCs must incorporate a sliding scale that takes time to create and set up. Essentially, not having solid numbers while implementing a sliding scale can potentially impact your facility’s finances.
• Balanced payer mix – During the scheduling process, FQHCs must achieve a healthy payer mix. Improperly managing the schedule may contribute to revenue burden, especially for specialties that provide services with global fees (e.g., OB/GYN care that includes all related and follow-up care within a specified period). FQHCs must have a well-balanced schedule for every payer type without any risk of creating gaps in the payment process that result from heavy scheduling of one type of payer, visit, or service. Scheduling appointments may involve some trial and error.
• Familiarity with payer contracts – There is a higher percentage of commercial insurance members using FQHCs for their healthcare. This means you must know their contracts and have the ability to navigate its billing and coding processes. FQHCS are bound by traditional commercial carrier contracts. Such contracts must be worded to enable them to implement the sliding fee process for members eligible for the discount based on their income. Without the proper and specific wording, you may find yourself in breach of that contract. These contracts enforce specific rules, particularly, instructing providers on their duty to collect copays or deductibles.
• Specific Coding Services – FQHCs are subject to the guidelines of the payment system established by the Centers for Medicare & Medicaid Services (CMS). This reimbursement process is based on a predetermined, fixed amount regardless of the level of care. Due to visits that are often reimbursed at a fixed rate, FQHCs are more likely to underestimate the need for proper coding. If in the private sector overcoding often becomes an issue, FQHCs are susceptible to suffering from chronic undercoding. FQHC coding services require knowledge of CPT codes and which ones are part of more extensive services. Billing will be a challenge because of specific payer requirements for claims submission. Revenue codes and UB-type of bill codes can also vary, making it a necessity to have billers who can skillfully differentiate the claims submission process for each type of visit, to each type of payer, and for each type of service provided. 

Benefits of Using Coronis Health Medical Billing Service for FQHC

With over 100+ years of combined experience, the Coronis Health team of experts knows FQHC medical billing and coding. We are well versed in sliding scale, UDS reporting, cost-based Medicaid reimbursement, school-based health centers, dental claims, substance abuse/detox billing, UGS/NGS Medicare, and other FQHC-centric specialties. Our medical billing services and revenue cycle management services are designed with FQHCs and CHCs in mind. Our goal is to remove the burden of medical billing so our clients can enjoy a healthy bottom line that leads to the growth and expansion of patient services.

Not only do we take care of medical billing services, but Coronis Health also works to improve every part of your revenue cycle, including getting credentialed and paid by providers. Our forward-thinking 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, scheduling process, complex payer mix, provider medical coding, practice management (PM) system optimization, and extensive denials management. By going beyond the billing department, we can identify the source of cash leaks and then work with your team to stop them at the source.

Our proprietary medical billing and coding review software is designed to track claim status and allows us to improve your first-pass rate drastically. By identifying these medical billing trends, future denials are avoided, and your facility can collect every dollar you deserve. Our medical billing software works independent of your practice management (PM) system, meaning there is no need to change your current PM system. Coronis Health is well versed in many of the top PM systems.

Payers frequently make changes to documentation and coding requirements. This practice can lead to denials and increased AR costs, which most FQHCs do not have the bandwidth to handle. Coronis Health not only understands payer contracts but offers coding compliance and auditing services to manage your current coding and documentation practices. Our team also provides support in identifying documentation insufficiencies and errors as well as avoiding under-coding, while giving recommendations on how to improve and correct clinical documentation for a more efficient and accurate process. 

Coronis Health can help you improve in the following areas:

• Front desk concerns, including eligibility
• Provider coding accuracy (CPT, ICD-10)
• 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

Our high-touch approach features a customer service team that is knowledgeable, courteous, and always efficient. Our multi-lingual team strives to provide an exemplary experience to each of your patients. From our COO to our call center staff, Coronis Health believes that every member of our team is a key part of our client’s success story. We believe that we succeed only if you do.

What your Medical Billing Consultation will Look Like

Consulting with Coronis health is the more technical term for “having a fresh pair of eyes look over your work,” and every professional respects the value of gaining an outside perspective.

Coronis Health will analyze your current system and determine the best options for streamlining your processes to achieve more efficiency. We will recommend the best practices for creating a process for collecting at the front and back end of the revenue cycle and equipping your staff to take care of collections successfully. 

Coronis Health works extensively with FQHCs, so we understand your world. We recognize what makes billing and reimbursement for community health centers unique. Coronis’s clients also have the unique advantage of our extensive FQHC-only reporting and benchmarking against FQHC peers. With over 2 million FQHC encounters processed annually, Coronis’s reporting and benchmarking allow FQHC Administrators and Board Members to clearly see strengths and future revenue opportunities.

Coronis Health has the experience and expertise to manage the entire revenue cycle of your FQHC. Are you ready to maximize your processes and free up your time for patient care?