Tag: fqhc

How Medical Billing Companies Help FQHCs Improve Revenue Cycle Management

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.FQHC billing team

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 In such cases, the patient is contacted in advance and then requested to update any information that may be missing/ out-of-date.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.

The Evolution of Patient Billing Processes for Health & Medical Practices

The complex nature of medical billing and coding has changed extensively over the years. These changes in medical billing have taken place directly alongside the ever evolving technology of computer, digitization, and new ways of doing business. medical billing and coding

This trend is likely to continue as new ways and methods of handling medical billing and coding have arose and continue to evolve in modern business and work environments. As the frameworks continue to expand, so does the number of specialized billing consultants who offer focused expertise in certain areas of health care, such as surgery, chiropractic, OB/GYN, pediatrics and pain management.

What the future will bring to medical billing and coding is slowly taking shape and medical practices now are embracing the changes taking place within the industry.

Highly Specialized Billing Consultants

Soon there will be more and more medical billing consultants who specialize in helping the different types of practices. With the federally qualified health center reimbursement practices already in place, more and more qualified FQHC billing consultants will become available to the practices that need them and their help. Such is also the case with community health center (CHC) consultants as the CHC neighborhood health centers network has and continues to grow along with federally qualified health centers (FQHCs).

The fact that community health centers serve underprivileged persons such as those who have little or no income, those who do not have medical insurance or less than adequate health insurance as pertains to their individual needs and is available in areas where there is little access to primary health care. Low income families and individuals tend to need health care the most and the fact that there is a network in place to help them means the need for billing and coding specialists will only become greater as it has in recent years.

Mitigating Low Income Medical Billing for CHCs and FQHCs

The populations designated by the Health Resources and Services Administration are defined as having too few primary care providers, high infant mortality, high poverty and/or high elderly population. Health Professional Shortage Areas are designated by Health Resources and Services as having a lack and shortage of primary medical care, dental and or mental health providers.

As a result, these groups, depending the geographic location of a county or general service area, comprise of a demographic consisting of a low income population. These groups often rely on certain medical institutional environments like comprehensive health centers, federally qualified health centers, or other public facility serving the low income demographic.

With community health centers receiving funding from the federal government and also being locally funded, some of the health clinics within the network are quite surprisingly modernized with electronic medical records and new equipment and this trend is expected to continue due to the financial backing the clinics have which allows them to serve the many underprivileged patients who without programs being in place would rarely be able to afford to get the care they so desperately need.

FQHCs and CHCs are here to stay and will only expand thanks to the financial support already in place. The fact is medical billing and coding outside of medical offices and providers serving the wealthy and well off will see advancements in all parts of the medical industry mostly because health care is being provided and paid for.

However, for FQHC billing and community health center billing, the changes will be even more drastic. Whether by patients and insurance companies or by government assistance, science and medicine will only develop further which in turn will create a demand for more medical billers and coders and more efficient medical billing practices to maximize effectiveness.