The growing challenges of FQHC billing are an uphill battle for healthcare providers. They have to administer patients, while taking care of revenue cycle management. Both tasks require time and effort, but healthcare providers often run short of time.
Whether it is making sure FQHC billing is accurate, or it is following all billing rules and regulations, healthcare providers need thorough preparation. AR and denial management need healthcare providers' equal attention. Outsourcing saves the day for FQHCs and helps healthcare providers offer quality patient care while maximizing billing efficiency.
Outsourcing can play a fundamental role in uplifting Federally Qualified Health Centers and boosting the bottom line. If you are wondering how, Then, this blog is written just for you!
Read this blog and explore how outsourcing FQHC billing can increase operational productivity and redefine your revenue cycle management.
What Makes FQHC Billing Challenges Unique?
The way a healthcare provider receives reimbursement is very different for FQHC billing. FQHCs have to follow the guidelines of two major frameworks: HRSA (Health Resources and Services Administration) and CMS (Centers for Medicare & Medicaid Services).
HRSA sets financial compliance for FQHCs and acts as a funder and regulator. There are certain requirements imposed by HRSA, such as Sliding Fee Scale (SFS), Uniform Data System (UDS) reporting, and 340B Program Compliance.
On the other hand, FQHCs have to meet CMS billing rules, which include Prospective Payment System (PPS) for Medicare, Medicaid Payment Models (State-Specific), Revenue Code Usage, and Cost Reporting.
All these factors collectively increase the complexity of medical billing for FQHCs. While you may understand these terms, being an expert at all these requirements may not be possible.
In addition to the guidelines set by HRSA and CMS, there is a long list of challenges that FQHCs face. That is why FQHCs need proper administrative assistance to enhance their revenue and make their practice profitable.
Digging Deeper into FQHC Billing and the Role of Experts
You know that providing affordable care to socially disadvantaged groups is the first priority of federally qualified health centers. Even if people don’t have their insurance coverage, you still have to manage offering them proper medical care.
Statutory rules and guidelines are one thing, but the entire administrative process faces issues leading to operational disruptions and improper revenue flow.
If you want to elevate your FQHC billing process, you must think beyond revenue cycle management. The first step is identifying the challenges in your journey towards maximum reimbursement.
FQHC provides medical assistance to various medical specialties, including general medicine, dental aid, behavioral healthcare, care for substance use disorder (SUD), vision-related issues, and more. Each medical specialty has very different requirements in terms of billing codes, documentation standards, compliance guidelines, and more.
These are just basic issues; FQHC billing is even more complicated than his. Let’s look at different aspects point-wise:
1. Healthcare practices must accommodate a dual system for catering to payer contracts and meeting HRSA’s SFS requirements (Sliding Fee Scale Integration). They must do income verification of patients and categorize their bills under bad debts and sliding fee adjustments.
2. FQHCs must make both reimbursable and non-reimbursable services a part of billing to avoid loss of revenue.
3. FQHCs also have same-day visit restrictions, and they can’t bill multiple encounters with a patient on the same day. There are exceptions to this rule in case medical treatment is paired with dental services or mental health assistance. This limits revenue and requires tight scheduling policies, EHR flags, and billing system safeguards to avoid denials.
4. There are alternative payment methodologies (APMs) and wrap-around payments for Medicaid. Wraps usually require tracking visit-level payments and quarterly reporting and adjustments.
5. When it comes to coding, FQHCs bill under G-codes (G0466–G0470) for Medicare or Medicaid PPS billing. These codes are not standard CPT E/M codes. Only qualified FQHC visits are billable.
6. When FQHCs are not technologically advanced, they often struggle to maintain a billing system that caters to electronic health records (EHR) and other important factors of medical billing.
How Does Outsourcing Improve Revenue Cycle Management for FQHCs?
FQHC billing is no cakewalk, and it requires assistance from experts to stabilize the financial performance and enhance the operational workflow. What outsourcing can do for FQHCs that in-house billing teams can’t do, it is freedom to only focus on patients and leave the rest to professionals.
Accurate Medical Billing with a Reduction in Denials
Outsourcing offers expert medical billing services with a wide range of effective solutions for administrative complexities. They also help reduce documentation errors, making the process accurate. As a result, there is a reduction in denials and revenue losses.
Faster Claim Control and Better Revenue Cycle Management
In FQHC billing, professionals contribute to streamlined revenue cycle management and better operational flow. When all medical billing steps happen efficiently, it leads to accelerated claim management and processing. This favors healthcare practices and improves their revenue.
Easier Compliance and Regulatory Guidelines
Meeting compliance standards and following regulatory guidelines becomes easy when you partner with a reliable FQHC billing company. Whether it's HIPAA compliance or other coding guidelines, medical billing services solve the issue for you.
Deep Insight into Administrative Process & Visible Results
Other than medical billing and coding services, you get a clear insight into your administrative process along with an overall review. This helps you set the stepping stone and improve the problematic areas. Also, with the assistance of qualified coders and billers, you see visible results in your medical billing process.
Better Handling of Coding with Higher Efficiency Rates
Medical billing services employ certified coders and billers who handle coding with precision and lead the practice towards higher efficiency and a clean claims rate.
Focus on AR and Denial Management
Even in the case of AR and denial management, outsourcing helps you recover lost revenue through denial resolution and reduce AR days by keeping a proper check on the status of AR.
Summary
FQHC billing requires undivided attention, and outsourcing can be helpful in doing that. There is a lot that healthcare providers can solve if they simplify choosing a suitable medical billing partner. There is a visible reduction in errors with efficiency in all billing steps. The only task at hand is selecting the right medical billing partner, and we have a valid suggestion for you.
Eminence RCM is the medical billing partner you are searching for. We offer a complete range of services for FQHCs and other healthcare specialties. Our team handles everything from simplifying your verification process to cutting errors during documentation, accelerating the submission process, optimizing denial management, and doing payment posting.
Try shifting to expert FQHC billing with our services and see the results yourself. To know more about our services, contact us!
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