Federally qualified healthcare centers (FQHCs) are playing a greater role in healthcare these days. Many now offer some specialty services as well as primary care and dental. This can make traversing the FQHC revenue cycle process and billing procedures quite a chore. Here is what you can do to triumph over the obstacles that come with FQHC billing.
FQHC Fees Have to Include Sliding Fees
FQHCs are given a higher rate for the population under Medicaid and Medicare. However, on top of that, they must operate a sliding fee for anyone who is not insured. Patients have a financial assessment filled out to find out whether they are eligible for being provided with discounted services. While there are various methods for figuring out how to charge patients for each of their eligible discounted slides, the easiest way to handle things is to have an all-inclusive charge that is applied for each slide, depending on the qualifications of the patient.
You must scrutinize every service an FQHC provides and get a cost analysis finished. Doing so allows you to offer services to people who can’t afford standard costs while still maintaining a good revenue cycle.
Balance Your Payer Mix
Another obstacle in an FQHC is trying to get a healthy payer mix in the midst of your scheduling process. Without proper scheduling, especially in the case of specialties that offer services that come with global fees, your revenue burden can become even greater.
If you have a well-balanced schedule that consists of all types of payers, you will maintain a healthy revenue stream and avoid the risks of having gaps in your payment processes because of being overscheduled in a specific type of visit or service.
Understand Your Payer Contracts
Because of how many commercial insurance members there are that currently use FQHCs for healthcare, you want to know their contracts and know how to traverse their coding and billing processes. An FQHC has to abide by their commercial carriers’ contracts; however, the contracts have to be phrased in a manner that lets the FQHC implement sliding fee processes for any member who qualifies for slide discounts, depending on what their income level is.
While FQHCs can offer discounts to qualified members who have higher deductibles, you risk violating contracts unless they are worded specifically to enable these actions. It is the contracts that put these specific rules into place, and it is the role of the providers to abide by these contracts, collecting deductibles and copays, etc. in their entirety.
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