Self-Pay Revenue Management

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FQHC Expansion Opportunities

November 5, 2018 - 8:45 PM

The most productive communities are communities with healthy individuals. Community Health has become the nations healthcare provider for poverty level patients. The affordable services allow individuals in our communities to get treatment without debt. Community Health centers also provide employment opportunities to our communities. reported roughly 207,656 FTE   staff in 2017. Affordable healthcare exists but more than 90 million live in medically underserved communities.  Community Health has lots of opportunities but the challenges for health centers will be the ability to handle growth.

The Community Health Center Fund which provides 70% of all grant funding. Funding health centers rely on was not renewed until February 9, 2018. Many health centers had already started making strategic business decisions to sustain operations. The health center patient population is primarily insured by Medicaid. The cost of service is higher than the Medicaid reimbursement rates creating this reliance on outside funding. The funding isn’t endless so it’s important that these health centers grow, develop and prove to be successful.

Lots of inefficiencies can happen with growth. Health centers juggle staffing, billing, patients, equipment, facility, technology and the list goes on and on. One of the most critical operational responsibilities is billing. This is how you get paid and the department can be the behemoth of inefficiencies if not managed correctly. Billing personnel will come and go and each organization manager will have different workflows. It’s best practice to create procedures for each workflow. Billing managers should create procedures that can easily be measured. This will create standardization within the organization. Transparency should be a focus. Patients will have questions and your billing staff should be providing consistent answers. Create scripts and train your resources on patient policies and billing procedures.  Provide patient-friendly notices. Don’t cause more work in your office if you don’t have to.  Lots of patient calls can be prevented if your patient understands their bill. Last, consistently be scan your existing patient self-pay for Medicaid. You don’t want to miss any Medicaid billing opportunities.


Optimizing health centers will provide the most impactful change. Join EmeraldAR’s group of leading FQHC’s to help your health center handle growth.


Written by Acooper32

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