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FQHC Requirements: How Proper Billing Improves Your Bottom Line

Mar 7, 2024 1:56:11 PM / by Altruis

FQHC Requirements: How Proper Billing Improves Your Bottom Line

Are your associates fully up to date on the latest FQHC requirements? In the fast-paced world of healthcare, knowledge quickly goes stale and it’s a constant challenge to stay current.

The Health Resources and Services Administration (HRSA) has a long list of medical billing guidelines for FQHCs and other federally funded health centers. There are also strict FQHC requirements for Medicare, Medicaid, and other government payment sources.

FQHC Requirements for Medicaid and Medicare

FQHC billing for Medicaid and Medicare are essential sources of revenue for any community healthcare organization. Medicare billing is growing more complex as Medicare Advantage becomes a dominant force in the U.S. healthcare landscape, but if you handle Medicare Advantage correctly, it can become one of your primary sources of revenue. 

Above all else, a strong financial status allows your clinic to provide the best possible patient care. With these issues in mind, let’s look at how following the latest medical billing guidelines will ensure your FQHC maintains a healthy bottom line.

How to Set the Stage for Fast, Accurate Billing

Effective FQHC billing begins long before a patient ever arrives for an appointment at your clinic. The moment they set foot in your practice, you should already have their basic contact information and coverage details ready in your system.

Both patient eligibility verification and provider credentialing are extremely important to establishing completeness and accuracy in your records. Any mistake or missing data could create a roadblock to prompt payment later.

Is all of your provider information 100% up to date at all times? When your clinic hires a new doctor, vet their background and credentials as part of your provider credentialing plan. Monitor this information on an ongoing basis to ensure every provider continues to be fully eligible for service reimbursement.

Medical coding also plays an essential role in this process. Old or incorrect codes create roadblocks to fast billing. When your associates are using the latest medical codes, your billing will go more smoothly and there’s minimal risk of losing out on payments — or waiting for them for 90 to 120 days — due to inaccurate coding.

Bill Accurately the First Time and Every Time

Every bill and reimbursement request your clinic generates has hundreds of fields where there could be a missing piece of information. An incorrect keystroke or skipped field may result in an unpaid claim.

Prevent inaccuracies and omissions by establishing a clear, reliable billing process and training your team on what to do when questions arise. Follow the latest rules for electronic health records (EHR) as required by federal agencies. 

Since 2011, the federal government has been instituting new rules encouraging the use of EHR and setting electronic data management standards for most payments that go through Medicare, Medicaid, and other programs. In 2022, new interoperability rules were implemented that are now impacting many types of healthcare organizations, so make sure your associates are fully up to date. 

Every Denial is an Opportunity for More Revenue

When your clinic receives rejections and denials from the Centers for Medicare and Medicaid Services (CMS), the next steps your associates take will make a major difference in collections. A rejected or denied claim will ultimately become an unpaid claim if there is no attempt to resolve it.

A rejected claim is one that failed to meet the system’s minimum requirements. It’s not even considered a billed claim for the beneficiary, and the provider will be notified of the rejection. This is an opportunity to address the issue that led to the rejection, resubmit the claim, and send it forward through adjudication.

A denied claim has been through adjudication and the payor has determined that it should not be paid. This is still not the end of the road, and your clinic has an opportunity to make a modification or add enough documentation to overturn the denial through an appeal.

Busy FQHCs are often so busy providing patient care that rejected and denied claims fall to the bottom of the to-do list. It takes an FQHC billing partner like Altruis to step in and get a handle on the situation, addressing pending claims and moving them into the stage of successful reimbursement.

At Altruis, we can even go a step beyond handling the daily flow of rejections and denials to implement innovative revenue cycle management strategies. For example, RetroPayTM is an effective way to recapture aging reimbursements that weren’t previously pursued because it seemed that the patient was uninsured. Retroactive coverage is applied, and these unpaid claims become revenue.

Stay Ahead of FQHC Requirements With Altruis

If your FQHC is straining under the burden of FQHC requirements, allow Altruis to work as your partner in medical billing. We’ll get to work right away, lifting your load of pending payments while helping you find fresh strategies for future success. 

Our partnership benefits you at every stage in the billing and RCM process. We’ll help you address challenging issues, stimulate new cash flow, ramp up your collection rates, and ease your stress so you can focus on providing excellent patient care. 

To learn more about FQHC billing, schedule a call with us today.

How Altruis Can Help


Topics: FQHC Requirements, FQHC Billing, Medical Billing Guidelines


Written by Altruis

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