Altruis explains how revenue cycle management resolves your community health organization’s top obstacles to greater profitability.
Community health organizations often face challenges with securing reimbursements and keeping revenue streams flowing. These challenges limit profitability and can even cause a provider to become so unstable it’s impossible to effectively serve the community.
The process of revenue cycle management offers a ray of hope in this complex environment. Challenges become opportunities to capture more revenue by facilitating repayment claims, minimizing wasteful activities, and securing previously untapped resources.
Here are some of the most common revenue cycle management challenges and how healthcare organizations are resolving them with profitable new solutions.
Claiming FQHC Revenue
Is your practice one of approximately 1,400 Federally Qualified Health Centers (FQHCs) with the Health Resources and Services Administration (HRSA)? On any given day, about 1 in 5 rural residents in the U.S. are served by FQHC programs, with steady growth among FQHCs of about 2% since 2017.
The challenge comes in securing reliable reimbursements. Federally-funded programs like Medicare and Medicaid will refuse to pay FQHC reimbursements when providers and practitioners make missteps in following the rules.
Even the most diligent FQHCs often have low reimbursement rates and high denial rates. Plus, a recent financial analysis of state FQHCs found a 51% drop in operating margins. Broadly speaking, ongoing increases in operating costs are outpacing healthcare centers’ capacity to maintain revenue growth.
The solution is found in overcoming an array of billing and reimbursement issues that plague most FQHCs. To learn more about the details of these reimbursement solutions, continue reading the next section about overcoming common billing, coding, and credentialing issues.
Billing, Coding, and Credentialing Challenges
Do you have a medical coding specialist on staff? Is someone in charge of dealing with preemptive credentialing, plus readdressing previously denied claims? It’s a lot to manage.
Fast, accurate medical coding and credentialing speed up the billing cycle for FQHCs and other types of community health centers, ensuring payments arrive at healthcare organizations on schedule. Greater accuracy also prevents denials that lead to dead-ends in reimbursements.
A revenue cycle management partner relieves the burdens of coding and credentialing from your office staff. The right billing partner handles your ongoing medical billing and reimbursement issues with keen attention to detail, freeing your employees to focus on your practice’s patient care.
Leverage Data to Focus on AR
The average community health center has a long queue of pending and denied claims that need attention day after day. A large majority of these claims can still be modified and resubmitted for reimbursement consideration if someone has the time and knowledge to make it happen.
It is important to review the rejections and denials created every month to identify the cause. This allows for making workflow improvements on the front-end to reduce future errors. Working the rejections daily to ensure proper submission and receipt by the payor and prioritizing denials to prevent timely filing issues need to be a focus on the back-end. Working the denials with that largest balances can also ensure that you are maximizing your AR efforts.
Uninsured Collections Recovery and Missed Revenue Opportunities
This is the concept behind Altruis RetroPayTM. It’s a revenue cycle management optimization tool that allows healthcare practices to capture revenue by identifying retroactive coverage for uninsured patients. These encounters are then billed to the appropriate Medicaid or MCO plan for reimbursement. Eliminating the patient's responsibility.
RetroPayTM revenue comes from insurance, not your patients, so they won’t have to worry about being charged. For example, an Altruis healthcare facility recovered an initial influx of $500,000 plus $100,000 in monthly RetroPayTM revenue from previously unclaimed charges.
Compliance and Regulatory Changes
In healthcare, staying up-to-date on new standards is a constant battle. Legislative and regulatory changes constantly shift the landscape of healthcare compliance.
Altruis consistently stays ahead of healthcare trends and changes in regulatory standards. We’re staffed by experienced healthcare professionals and billing experts who take pride in working at the forefront of healthcare innovation.
When you select Altruis as your revenue cycle management partner, we make it our mission to handle your billing activities with care and professionalism. We’ll locate fresh sources of revenue, stabilize your reimbursement flow, and improve your profitability.
Altruis provides peace of mind and allows you to focus on what’s always most important in the healthcare field: providing high-quality patient care.
To learn more, schedule a call with Altruis today.