FQHC Community Health Centers billing and accounts receivable

An FQHC is not paid fee-for-service. It is paid an encounter rate under a prospective payment system, and applying a commercial billing workflow to it produces denials and programme problems together.

Where the money leaks in fqhc community health centers

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Encounter-rate claim billed as fee-for-service, or a wrap-around payment never pursued
• Two encounters on the same day billed when the programme pays one, or one billed when an exception applies
• Sliding-fee discounts applied inconsistently with the schedule on file
• Services by a non-qualifying provider type billed as a billable visit
• Medicaid managed care claims worked as if they followed the state's fee-for-service rules

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

Questions