Most of the FQHCs in the U.S. face serious challenges in maintaining their patient billing systems and also in managing their revenue cycles. As a result, many FQHCs seek the services of medical billing companies in order to address these challenges.
Medical billing companies help FQHCs with their patient billing systems and overall revenue cycle management by taking the following measures:
1. Ensuring proper registration by using checklists – By so doing, the companies enable FQHCs to reduce the claims that are usually rejected because of ineligibility, non-authorization of services or missing patients’ information.
The officer who registers the patient usually obtains photocopies of the patients’ insurance cards and also verifies personal information, contact information and identities of the patients.
2. Practicing pre-admission contact – Most of the medical billing companies have embraced pre-service/pre-admission contact for scheduled/elective procedures. In such cases, the patient is contacted in advance and then requested to update any information that may be missing/ out-of-date. The two parties also make payment plans, whereby the prospective patient is asked to pay long before the procedure is carried out or on arrival at the FQHC.
3. Establishing a retail mindset – Typically, the contracted companies enhance FQHC billing systems by devising ways of effectively collecting payments without necessarily damaging existing relationships with their clients, and this is achieved by embracing what conventional retailers do.
This usually involves one or more of the following actions; providing prospective patients with detailed information concerning the upcoming procedures and the respective payment expectations, offering small gifts when asking for payment, informing them that they can pay using credit cards and establishing payment collection systems as routine parts of the registration work-flow.
4. Establishment of strict regulations to guide the claims submission process – By meeting proper regulations, medical billing companies enable FQHCs to avoid factors that usually result in denial of claims by the parties that are supposed to reimburse the FQHCs.
Some of the factors that are thus avoided (by establishing strict regulations to guide the claims submission process) include; patient eligibility, coding errors, incomplete patient information, claims presented to the wrong parties, missing supplemental attachments, submission of duplicate claims and incomplete service information.
5. Regular examination of contracts with main suppliers – By taking this measure, medical billing companies help FQHCs by ensuring that they get paid in time and according to the conditions stated in the contract, and that the FQHCs always bill the creditors correctly. They also ensure that creditors don’t intentionally or unintentionally make mistakes when making payments to the FQHCs, and that they always get value for their money.
6. Replacement of manual systems with electronic payment systems – Electronic systems are better than manual systems because they are more efficient, safer, more effective, cheaper, and more reliable. Electronic systems are also less susceptible to manipulation by dishonest employees, and can be simultaneously used by different parties even if they are in different physical/ geographical locations. This measure can significantly enhance FQHC billing systems.
7. Matching electronic remittances with actual payments received – most of the companies boost FQHC billing systems by ensuring that electronic remittances always match/correspond with actual payments received. They rarely post/submit the electronic remittances before receiving/confirming actual payments. This helps in avoiding unfortunate incidences whereby the A/R is updated and yet the money hasn’t actually reached the bank account.
By taking the measures explained above, medical billing companies effectively help FQHCs with patient billing systems and overall revenue cycle management.