Altruis Blog

When it comes to billing, Medicare reimbursement is a vital revenue stream for most federally qualified health centers (FQHCs). But many centers are missing out on the additional revenue they’re owed for Medicare Advantage patients.

This is a growing concern for FQHCs as an increasing number of patients are choosing Medicare Advantage plans. Over the years, most Medicare beneficiaries opted for traditional Medicare plans, but a growing percentage of patients are enrolling in Medicare Advantage plans instead. In 2022, 45 percent of Medicare beneficiaries were enrolled in Medicare Advantage plans, but this figure is anticipated to surpass 50 percent by 2025—which means federally qualified health centers could be missing out on more potential revenue every year if they don’t submit for these reimbursements.

Many FQHCs have questions about Medicare reimbursement. Here’s what FQHC leaders and billing professionals need to know about these supplemental Medicare payments:

When it comes to medical billing collection rates, the phrase “no margin, no mission” can ring too true. After all, if a care center doesn’t bring in enough revenue to keep things running, any higher purpose they have is meaningless. That’s why you devote so much time to keeping your center or federally qualified health center afloat. But it’s important to remember that the reverse of this well-known phrase is also true: No mission, no margin. If you’re devoting too much time to the billing side of your practice, it’s the patients who suffer.

Changes to payments and premiums plus new venues for care dominate the news. How have you changed the way you access healthcare? Would you augment visits to your primary care physician with a retail clinic? 

Providers and states are looking for ways to change the way they are being paid, while CMS comes under fire for not doing the best job in providing guidance on what they should be paid, even if they are following the rules. 

It seems the label “Medicare for All” is being attached to all sorts of proposals. Plans to provide universal healthcare coverage to Americans abound, but they aren’t all Medicare for All. Broadly speaking, “Medicare for All” applies to only those proposals that would cover everyone, replacing private insurance.