Altruis Blog

Medical Billing Mistakes: Waiting for Something to Go Wrong

Oct 9, 2023 4:22:55 PM / by Altruis

Medical Billing Mistakes

Medical billing is complex and there’s always the potential for mistakes to happen. Any problem can be costly for a federally qualified health center (FQHC) as it uses its scarce resources to serve medically underserved populations.

This article outlines common medical billing mistakes and how to avoid them through strong FQHC revenue cycle management.

Mistake #1: Rushing Into Quick Fixes

When something is going wrong with your revenue cycle management (RCM) process, this puts pressure on your staff and takes the focus away from your patients. Small issues become bigger challenges to fix, often on short notice.

For example, misunderstanding the difference between medical claims rejections and denials can create a situation where your employees routinely give up too early in the process. Potentially successful claims are missed entirely or must be resubmitted at the last minute. Your clinic will constantly be chasing short deadlines and risking significant revenue loss. 

To prevent situations like this, work proactively to protect your revenue and prevent problems that could impact patient care. Create a comprehensive RCM strategy with the help of a healthcare revenue management expert.

Mistake #2: Ignoring Persistent Problems

Does your health center have any ongoing problems with its business operations? Accounts receivable (AR), credentialing, coding, and billing issues shouldn’t be ignored or they’ll only get worse.

Common struggles in the community healthcare field include high staff turnover, low staffing levels, AR backlogs, and difficulty addressing unpaid claims. The JAMA Health Forum reports an ongoing crisis in healthcare worker staffing levels since the start of the COVID-19 pandemic. Turnover is especially high among workers in historically marginalized racial and ethnic groups and women with young children.

Another trend involves managing healthcare in the post-pandemic era. The official end of the U.S. pandemic public health emergency (PHE) in May 2023 led to a scramble among FQHCs to ensure ongoing compliance with post-pandemic regulatory requirements

A sweeping new legislative package known as the Consolidated Appropriations Act, 2023 (CAA 2023) created significant policy changes FQHCs are obligated to follow, despite losing out on much-needed government resources that weren't included in CAA 2023. Keeping up with what’s happening with these regulations places an enormous strain on your already strained community health resources.

These aren’t easy challenges to address. Turnover has become an entrenched part of healthcare hiring. Regulatory changes are a constant in the medical field. The pressure is on FQHCs to serve the community as effectively as possible, so any business challenge becomes a community challenge in terms of maintaining the availability of healthcare for patients in your region.

While stronger RCM can’t solve every problem, it can ease the stress on your staff members and allow your clinic to continue operating productively. Here’s an example of how better RCM addresses a common struggle for FQHCs and other community health centers. 

Some healthcare organizations misunderstand the difference between gross and net margins. As a result, they aren’t measuring what matters and can’t develop a proper safety net to keep profit margins healthy enough to deliver the highest possible level of patient care.

A workable solution to this problem is to outsource medical billing. A full-service outsourced solution relieves your staff of this burden, allows them to focus on providing healthcare, and ensures you have experts handling your billing.

This, in turn, allows you to find other benefits like reallocating people and resources to expand into new patient services or finding innovative ways to use your staff more strategically. Outsourcing your billing tends to shorten the length of your claims process, speeding up your revenue cycle.

Mistake #3: Reaching a Crisis Point Before Asking for Help

Any doctor will tell you that it’s a mistake to allow a healthcare challenge to become a healthcare emergency. The same goes for medical billing challenges. 

Don’t allow your healthcare center to reach a crisis point before asking for help. There’s no need to wait for something to go wrong. Work with Altruis as your proactive partner in medical billing and FQHC revenue cycle management.

Altruis is one of the nation’s foremost FQHC billing services and we have extensive experience helping healthcare clinics follow RCM best practices to avoid costly mistakes. Altruis can optimize your billing process and find innovative ways to capture revenue and keep your organization healthy.

We’re here to help you succeed. Schedule a call with Altruis to learn more.


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Topics: fqhc billing services, fqhc revenue cycle management


Written by Altruis

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