How to Improve FQHC Revenue Cycle Management

April 25, 2023

Improving FQHC Revenue Cycle Management Image

As Federally Qualified Health Centers (FQHCs) continue to play a vital role in providing care to underserved populations, they must maintain a solid financial foundation to support their operations. One critical aspect is having an effective FQHC Revenue Cycle Management (RCM) strategy.

RCM refers to managing the financial interactions between patients, healthcare providers, and payers (insurance companies or government programs). Improving RCM can help FQHCs optimize revenue, reduce billing errors, and improve patient satisfaction. Here are some strategies for strengthening RCM:

Verify Patient Eligibility and Insurance Coverage:

Verifying patients’ eligibility and insurance coverage is crucial before providing services. This can help reduce the risk of billing errors and claim denials. According to a study published in the Journal of Medical Practice Management, 40% of claims are denied due to eligibility or benefit issues.

Improving Coding and Documentation:

Accurate and complete coding and documentation are vital to optimizing revenue. Providers should ensure that their documentation supports the services provided and that medical codes accurately reflect the level of care. A study published in the Journal of the American Medical Association found that up to 42% of claims are denied due to coding issues.

Streamline the Billing Process:

A streamlined billing process can help reduce errors and speed up payment. This includes having clear and concise billing statements, automating payment posting, and using electronic data interchange (EDI) to submit claims. According to the Medical Group Management Association (MGMA), EDI practices have a 63% lower claims rejection rate than those that don’t.

Improve Patient Collections:

Collecting patient balances can be challenging, but it’s critical to maintaining a healthy revenue cycle. FQHCs should establish clear and consistent billing policies, offer payment plans or financial assistance, and train staff on effective patient communication. A survey by the MGMA found that practices that collect patient balances at the time of service have a 97% success rate, compared to only 57% for those that bill after the fact.

Implementing these strategies can help FQHCs improve their revenue cycle management and achieve financial stability. Brian Haug, CFO of a Texas-based FQHC, explains, “A strong revenue cycle management program is critical to the financial health of any FQHC, allowing us to provide high-quality care to our patients while sustaining our operations.”

In conclusion, effective RCM is essential to the success of FQHCs. By verifying patient eligibility and insurance coverage, optimizing coding and documentation, streamlining the billing process, and improving patient collections, FQHCs can enhance their financial performance and continue to provide vital care to underserved communities.

CPa Medical Billing, a GeBBS Healthcare company, Specializes in FQHC Revenue Cycle Management

Federally Qualified Health Center (FQHC) and Community Health Center (CHC) revenue cycle management services are a part of the foundation at CPa Medical Billing (CPaMB), and our team of experts is widely known as being one of the best FQHC RCM teams throughout the United States.

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Posted in Medical Billing Insights