Contrary to what many people believe, successfully maintaining the revenue of a Federally Qualified Health Center (FQHC) is a relatively complex undertaking. This is mainly due to the fact that there are several different departments that need to work efficiently and in tandem so as to maximize revenue from patient billings.
Invest in professional FQHC billing consulting services
As earlier mentioned, billing systems for a Federally Qualified Health Center (FQHC) is no walk in the park; it is a highly technical and demanding activity that demands for professionals.
In this regard, it is important to engage the services of a professional medical billing consulting firm to assist with best practices of patient billing and coding so as to maximize efficiency with FQHC billing software systems and significantly improve overall revenue collection figures.
FQHC billing consultants usually suggest proposals for improving billing processes. These suggestions may include an improvement in processes such as software file maintenance, claim and payment receipt tracking, fee schedule analysis as well as processing of insurance claims.
Understand and appreciate the overall cycle of revenue
To improve FQHC billing processes, it is important to fully appreciate the overall cycle of revenue of that particular facility. Even though many facilities tend to believe that the submission and subsequent payment of claims forms the actual billing process, the truth is that the billing process begins immediately a patient makes an appointment and ends after the patient has been attended to and pays the billed amounts.
The billing cycle should therefore properly establish the requisite channels from patient registration, charge entry, payment posting and ending with the necessary follow up on accounts receivable.
Ensure all charges are captured
To avoid challenges with FQHC billing, it is important to ensure on a daily basis that all appointment schedules are reconciled with encounter forms. This is one simple way of ensuring that each and every patient gets attended to and the correct charge corresponds to each patient that’s been attended to in the facility.
Typically, the sum of the charges on the encounter forms must then be reconciled daily in the reports that are generated by the management system. By doing this, the facility will be able to easily track forms that may be missing so as to ensure revenue maximization.
Review and accurately update fee schedules
It is important to review fee schedules as the market demands, be it annually, semi-annually or quarterly. It is important to ensure the charges are not only realistic and set for all codes but also accurate. Make a point of comparing the fees with other Medicare or contracted fees charged by other players. Since insurance companies tend to pay lower than the billed amount, billing lower than the amount contracted will result in revenue loss for the facility.
Accurately collect patient information
With each visit, make sure patient insurance details are accurately captured. As is the norm, patients should always produce copies of their insurance card. The person in charge of billing should also make a point of enquiring from patients any changes of address or insurance companies.
It is also important to verify patient social security numbers, this is especially so if it is the first visit. Verifying these details is important because sending a claim to the wrong company or address is bound to lead to significant delays in revenue generation and collection.