Altruis Blog

FQHCs evaluating a new billing partner often ask about price first and FQHC-specific experience second, if at all. FQHC billing services vary enormously in what they know about encounter-based reimbursement, wrap payments, and HRSA oversight. A vendor that handles general medical billing well can still miss the details that determine whether your health center collects what it is owed.

The variation exists because FQHC billing runs on a different rule set than general medical billing. Your organization operates under Medicare's Prospective Payment System, reconciles Medicaid wrap payments, and answers to HRSA site visit protocols that few billing companies encounter with any other client type.

We’ve compiled the eight questions a CFO should ask when comparing FQHC Billing services.

Your organization outsourced billing to fix a specific set of problems: understaffed positions, rising denials, an AR balance that kept climbing. A year or two later, the monthly report still lands on schedule, but the underlying numbers haven't moved the way you expected. Revenue can underperform for months without a single broken line item to point to.

A provider documents a same-day E/M visit and a minor procedure correctly, but a missing modifier 25 makes the claim look like a duplicate charge. The payer denies it as CO-4, and the twenty minutes of clinical work now costs the billing team another round of research, correction, and resubmission before it generates a dollar.

Revenue is leaving your health center every month through compounding, routine gaps in your billing cycle that individually look manageable but together represent a significant percentage of collectible revenue.

Every community health center approaches billing differently, and the structural decision your organization made, whether years ago or more recently, has direct consequences for revenue, staffing, and payer compliance.