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5 Tips to Optimize Your FQHC Billing Practices for 2016

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.

improve FQHC billiingIn order to lower costs, improve patient satisfaction and increase revenue, here are 5 tips to optimize FQHC billing practices, these include but are not limited to the following.

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.

5 Creative Health Center Billing Strategies for FQHCs

Virtually every medical practice has to bill patients, work with insurance carriers, and maintain billing records. Federally Qualified Health Centers (FQHCs) are no exception. And as a matter of fact, patient billing for FQHCs is much more complex than you can imagine. FQHCs have several departments that should work in an efficient manner to ensure seamlessness of the whole process of patient billings.

That is the reason FQHCs must create and implement effective policies and strategies for accurate patient billing. Another great benefit of solid policies is increased patient satisfaction. Below are five effective health center billing strategies for FQHCs to make the process seamless and successful.

fqhc billing strategies

Understand The Overall Billing System

First of all, it is of vital importance to understand the overall system of billing and revenue cycle in the health center to make sure the systems work as expected. Many health centers think that the real billing system is the submission and payment of claims. The fact of the matter is each staff member play a great role in making the billing process as smooth as possible.

The overall FQHC billing process starts when a patient sets an appointment and comes to an end when he or she gets the required treatment and pays the entire bill. The process of billing that should be in place should involve several steps, such as registration of the patient’s, charge entry, posting of payment and handling the accounts receivables.

Acquire Information From Patients

The FQHC staff should collect and implement and store accurate information about each patient , including insurance and demographics of the patient as soon as the patient enters the facility. On the first appointments, the staff should acquire information about insurance, birth date, phone number and residence address.

patient billing form

If you choose to work with an FQHC billing company, some companies provide access to software to help streamline this process. It’s important that your FQHC billing agency helps train staff on how to use this software properly and efficiently to acquire and record patient data.

Carry Out Reconciliation

Reconciliation of encounter forums with the schedule of appointment is another strategy for perfect billing system. The accounts department should then reconcile the total amounts with the reports generated by the management on a daily basis.

This allows the health facility to track all the missing encounter forms. As a result, this ensures that the whole process is seamless. The biggest benefit of this strategy is that it prevents the revenue loss.

Update The Fee Schedule Annually

The fee schedules of the FQHC should be updated on an annual basis. For fair revenue generation, the staff should set reasonable charges for the codes to ensure the achievement of reimbursements.

Another idea is to compare the fees with those of charged by other health centers. Here it should be noted that insurance companies don’t usually pay the full amount of the contract or amount billed, which means that charging lower than the contracted amount will lead to loss for the facility.

Let Each Patient Know The FQHC’s Billing & Financial Policies

Lastly, a health center or FQHC should let all its patients know about its FQHC billing and financial policies. For this, a single page with the financial policies written on it clearly should be given to each patient at the facility. Of course, it would be a summary of the FQHC billing policies.

Each patient should sign the document, and then the document should be put inside his medical treatment file. On the document, the payment terms, authorizations, information about insurance and cancellation policies should be clearly stated. This, in short, is health center billing best practices.

For keeping an FQHC in good shape, many strategies can be implemented, but starting with these five strategies can be good ideas. If these work for you, your facility can be really successful.