Overcoming FQHC Growth Challenges


FQHC Challenges

How to eliminate FQHC challenges by optimizing your billing operations

The most productive communities are those with healthy individuals. Community Health centers do just that, they provide the medical support our communities need to maintain good health. At a state and local level, we’ve all seen the need. The Federal government has acknowledged the need by creating the Community Health Center Fund in 2010 to pay for the operation and expansion of health centers through the nation. So far, they’ve appropriated close to 3.8 billion dollars. The money helps with the growth of these health centers, but it doesn’t solve all their problems.    Joan Quigley, President and CEO for North Hudson Community Action Corp, said “We are always struggling to keep up with funding”. The RAND research group conducted research on FQHC’s. A researcher said when asked about operational viability,  “Although many federally qualified health centers have historically provided patient-centered, team-based care, the implementation of other medical-home components, such as expanding access to care after hours and developing data-analytic capabilities, may present substantial challenges in health centers that have limited financial resources or high staff turnover,”. Today, I want to focus on the operational challenges. I’ve created some useful tips to help FQHC’s strategically overcome growth challenges and hopefully continue to be a source of strength to our communities.

Rapid Growth

Rapid growth can cause considerable inefficiencies.  Health centers juggle staffing, patients, equipment, facilities, technology, the list goes on and on. One of the most critical operational responsibilities is billing since this is how medical providers get paid. Billing departments have a lot of responsibilities and interruptions are constant. This can lead to inefficiencies or mismanagement. We’ve even experienced this in our own organization. We knew we wouldn’t be able to easily scale our operation without change so, we decided to implement Business Process Re-engineering [BPR]. This was an exercise we went through for our early-out and collection services. It transformed our departmental knowledge, BPR highlighted strengths and weaknesses within our policies and processes and brought our teams closer together through collaboration.

Before you get started, create a team that meets weekly. Their meeting purpose should be to identify and create billing policies and procedures that add value to your organization. Standardizing your processes and policies will make training a lot easier for your trainer and trainee. Your managers will be able to collaborate with other managers, they’ll identify bottlenecks in their respective areas, and the best part, this will find it easier to scale. BPR is a lot of work though! Make sure you have buy-in from all those that participate before you get started and make the meetings mandatory.

Billing Staff

Staffing is expensive. the Society for Human Resource Management states that the average cost to hire an employee is $4,129. Sometimes, it makes more sense to automate the work or outsource the position.  Typically, we’ll do this if we find the role spends a considerable amount of time performing manual processes. We did this with our Medicaid verification process. There was a time when resources manually searched for missed Medicaid via the Medicaid website. This took a considerable amount of time, so we created batch searching. This required lots of technical development but it replaced one resource allowing us to use the resource in another role. If we don’t have the time to create automation for every manual process but there are companies that have become experts at certain processes. If we can get an expert for a lower rate than an employee, we choose the expert.

Patient Transparency

Transparency builds trust.  Patients will have questions and your billing staff should be able to provide consistent answers. Create scripts and train your personnel on patient policies and billing procedures. We’ve created a client portal that lets our clients see customer service notes on each account, they have reports to measure our service success and the get access to communication tools needed to resolve patient accounts. For their patients, we provide patient-friendly statements.  They have a Spanish backside that helps your Spanish patient base understand their bill.  They’re colorful, legal size, they don’t have service description jargon and they include payments and adjustments. Giving your patients the information, they need to resolve their bill cuts down on patient calls, gives them a better experience and helps build a relationship of trust.

Emerald’s mission is to simplify the patient billing experience. We’ve spent years working to create efficient processes. Our processes have added a lot of value to Community Health Center billing departments around the nation.  We would like the opportunity to simplify your billing operation in an effort to make it more efficient and scalable. If your organization is ready to do the same then Let's Talk . 

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