Rural Health Clinics billing and accounts receivable
Soft Home Global works RHC accounts receivable, denials, eligibility and prior authorization as a full time seat inside your own system, from $1,700 per seat per month. The denials below are the ones that cost rural health clinics practices the most, and they are what a seat is trained to attack first.
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. 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
What are the most common rural health clinics denials?
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.
Do you have people who know rural health clinics?
Not a bench of rural health clinics specialists sitting idle — we would rather say so. A seat is trained on your specialty, your payer mix and your system for about a week, and stays on your account rather than rotating.
What does it cost?
An AR caller working denials is $1,700 per seat per month. Prior authorization is $1,900. A certified coder is $2,500. Full time, US hours, one month minimum.
Next step
Put one seat on your rural health clinics AR
Twenty minutes is enough to work out whether the denials above are the ones costing you money. If they are not, I will say so.
Or write to ops@softhomeglobal.com