Effective Tips to Optimize FQHC Patient Billing Procedures

Federally Qualified Health Centers (or FQHCs) are organizations that are able to receive grants under the Public Health Act. Most FQHCs service areas that have been traditionally underserved and they tend to offer residents of the area a sliding fee scale as well as providing them with comprehensive services.medical office doctor of FQHC

With that being said, maintaining the revenue stream for such an organization can be more complex that what most people may believe. Within FQHCs, there are a variety of departments that need to efficiently collaborate and work so that revenue can be maximized via patient billings.

Billing Challenges Faced by FQHCs

Consistently, healthcare centers that fall into this category seek revenue improvement, although they are extremely challenged by their static as well as declining volumes of patients, patient case reclassifications and regulatory framework. FQHCs tend to center their focus on the following methods as a measure of improving FQHC patient billing processes, financial health, and revenue streams.

Understanding the Overall Cycle of the Revenue

Having a clear understanding of the overall cycle being utilized in the revenue collection is an accepted and healthy practice when trying to optimize revenue streams. It is imperative that there is a clear process of billing that begins when a patient schedules an appointment and completes once the patients has been attended to and their debts have been cleared. When addressing the needs of a FQHC, the process should take into account the following:

  • Patient registration
  • Entry fee/charge
  • Payment posting
  • Accounts receivable follow-up

Capture All Charges and Review and Update Fee Schedules

doctor with FQHC billing filesDuring the process of billing, the staff of an FQHC should collect and enter all information accurately pertaining to demographics and insurance for the particular patient. The centers should have the following currently documented and on file for effective billing: home address, birth dates, telephone numbers, and insurance information.

In order to optimize the collection of revenue for an FQHC, the centers will need to reconcile their encounter forms and health schedules daily. This will allow for the health centers to track encounter forms that may have been (accidentally) missed and therefore decreases the avenues for lost revenue.

Reduce Out-of-Network Revenue Leakage

Most FQHCs have been known to have hired their physicians quite aggressively. Beyond the hiring technique, office related infrastructure expenses and incremental salaries can prove to be quite a burden on income statements.

It is best that health centers not acquire physician services and practices before taking the proper steps in regards to the limiting and prevention of out of network referrals. FQHCs should optimize their practices thoroughly and efficiently.

It is acceptable and needed for a health center to make proper use of their vendor applications that are able to deliver advanced clinical documentation features that coordinate proper care across a clinically integrated network. This will afford the center with a proper manner in which to shape and track scheduling as well as patient referrals.

Moreover, to maximize the revenue stream of an FQHC, there will need to be clear communication to the patients regarding the health centers financial and billing policies. There will need to be documentation detailing the policies that each patient will be required to read and sign. This documentation will need to expressly explain cancellation or collection of the institution’s policies, insurance information, authorization mechanisms, and terms of payment.