Rural Health Clinics billing and accounts receivable

RHCs bill an all-inclusive rate rather than a fee schedule, and the commonest loss is a practice billing them like an ordinary clinic and never noticing the difference.

Where the money leaks in rural health clinics

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.

• Visits billed fee-for-service instead of under the all-inclusive rate
• Qualifying visit code omitted, so the encounter does not pay at all
• Care management and preventive services billed against the wrong rate structure
• Non-RHC services mixed onto an RHC claim rather than billed separately
• Commercial payers billed under Medicare RHC rules that do not apply to them

What a seat does about it

One trained person works your queue from the difficult end, from our office in Rawalpindi, Pakistan, logged into your own system on your hours. 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. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — check yours before placing a restricted queue on this seat (more on /security/).

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

Questions