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FQHC Revenue Cycle Management, Credentialing & Enrollment

Macman Powered by Medusind

An Expert in RCM for Federally Qualified Health Centers (FQHC)

Medusind has joined forces with Macman Management Healthcare Services, which specializes in expediting FQHC billing and coding, credentialing and enrollment, and in supplying crucial ancillary services, so together we can see that over 30 million Americans get the health care they need—and deserve.

 

We support America community health centers by offering advanced, effective RCM services with critical logistics and analytic support.

 

Over 30 Million Americans Rely on FQHCs — and We’re Here to Support Them in a Time of Staffing Shortages and Expanding Reimbursement Opportunities.

The U.S. Health Resources and Services Administration (HRSA) funds almost 1,400 health centers and over 100 Health Center Program look-alike organizations, which operate more than 15,000 service delivery sites. They serve over 30 million underserved and uninsured Americans.

But right now, the world of FQHC is under fierce pressure, as a result of CMS expansion of services, Medicaid/MediCal Managed Care reporting requirements, and serious workforce shortages. 

How Can We Help You?

We offer three categories of services for FQHCs:

Financial Services

With the U.S population growing, FQHCs must deal with a shortage of providers, staff turnover, constantly changing regulations, advancing technology, and payer demands — all while providing access to care with fewer resource.

Our Revenue Cycle Management (RCM) services optimize processes and clinic/practice growth. For all-important claims, we work with your organization to ensure payor accuracy and to process charges for a clean claim, and we handle payment posting and denial management and reporting. Our denial management process includes working on both current and old accounts receivable to guarantee your organization is receiving the maximum reimbursements for services rendered. As part of our full RCM package, we provide training for front office staff and provider documentation/coding training, and we train any specific ancillary staff who support the accuracy of a clean claim during the initial billing process.

 

Additional Services

  • Assessments: We analyze your revenue cycle workflow from the front desk to denial management to meet your quality improvement needs, focusing on quality and revenue optimization.
  • Technical Assistance: We review your electronic health record workflow with an emphasis on documentation, coding and billing system set-up, and maintenance to ensure all payor requirements are met. We also provide customized training in many areas with a focus on compliance, quality, generating efficiencies, and optimization.

We perform oversight monitoring and help you meet regulatory requirements that affect your practice, so you have the most modern standards in place.

 

These services include:

  • HRSA SAC application preparation
  • HRSA BPR annual budget period renewal
  • Changes in scope of services
  • HRSA site visit preparation
  • HRSA annual federal financial report
  • HRSA prior approvals and carryover requests
  • New site licensure
  • Prospective Payment System (PPS) rate setting, planning, and annual reconciliation
  • Assisting in the preparation of government-required reports, such as:
    – UDS Report preparation of financial tables
    – OSHPD reporting by site
    – Annual Medicare and Medicare cost reporting
  • Financial/DHCS audit preparation
  • System for Award Management (SAM) registration
  • Preparation of supplemental grants
  • Annual budget

We undertake billing and coding audits based on your practice’s needs.

 

Billing Audit

We review the entire lifecycle of your claims in your billing system, based on current rules and regulations. We determine all levels of audit eligibility, and we report on charges captured, provider, location, submission, and adjudication of the claim. We capture all types of visits, including billable and non-billable visits and additional enabling services that the billing system tracks.

We can gear your billing audit to focus on a specific time range and other criteria, such as insurance based your clinic’s needs. We also offer billing analysis options for aging, payment posting, and denials.

 

Coding Audit

We can adjust our coding audit according to subject and your chosen scope of work. Typically, the following three areas are included in your coding audit scope:

  • Evaluation and management coding audit
  • CPT and HCPCS audit
  • ICD-10 diagnostic coding audit

We assess your chart documentation to prove medical necessity, how it supports the level of services rendered, and the linkage to the diagnosis.

Based on the audit findings, we offer additional services to help your clinic with the identified gaps and areas of improvement. These services can include items such as implantation, project management to a provider, and staff training.

While coding for services, our highly trained certified coders optimize your revenue while reducing compliance risk. This increases cash flow by reducing lag days and improves claims submission.

Clinical Services

Our clinical scope of services bridges the gap during provider transition and health center expansion of clinical sites (including programs and services), and we offer interim CMO services.

We can assess, develop, monitor, and maintain your organization’s compliance needs to introduce cost-effective models of implementation. Our vast experience with community health centers can assist you with your HRSA mock survey, reviewing policies and procedures.

Our peer review includes reviewing medical records, patient complaints and grievances, adverse clinical outcomes, and potential adverse events at the inpatient or outpatient level.

We provide:

  • Mid-level supervision
  • Mid-level consultations
  • Refill services
  • PAQs
  • Interim CMO services

To support the increased focus towards quality care and public reporting of provider-level data, our staff can enable you to meet state and federal guidelines, including becoming a Certified Patient Centered Medical Home and achieving Meaningful Use status.

We help you to collaborate with insurance networks to complete payor enrollment and credentialing for your organization’s healthcare providers. We specialize in provider and facility credentialing and recredentialing for FQHC and private organizations. Since this can be a long, tedious process, our team of credentialing experts follows up with payors until you become fully enrolled.

 

We have expert level understanding of:

  • CAQH management
  • CMS Medicare (PECOS) enrollment
  • Medical (PAVE) enrollment
  • Managed Care plan enrollment
  • Commercial plans enrollment
  • Behavioral health plan enrollment
  • Vision and dental plan enrollment

Administrative Services

We assess your practice to identify any operational gaps. After reviewing current workflows and determining opportunities for improvement, we develop a customized plan that fits your facility’s needs and implement best practices.

Today it’s hard to find qualified healthcare professionals. We provide highly skilled interim staffing experienced with community health centers. We can supply interim staff in Finance, Operations, or at the Executive officer level.

Our robust Patient Access Center assists community health centers in the management of patient billing calls, patient outreach, back-up for patient appointment reminders, and general scheduling services for appointments. We relieve community health centers of congestion so patients can access support, services, and appointments. Our staff is bilingual and experienced with community health centers.

(for Your Front Office, Back Office, and Billing)

We offer comprehensive, customized training for everything that makes your clinic run smoothly. We utilize coding tools, knowledge, and experience to train staff in a variety of areas. Our trainings are customized to your needs, payers, and systems.

We provide:

  • Basic training: core essentials from the front office staff to billers
    • Eligibility
    • Authorizations and referrals
    • Covered and non-covered services
  • Insurance training: including your payers such as Medicare, Medicare, Managed Care Medicare, special programs, and commercial payers
  • Denials training
    • Identifying the cause
    • Solutions and tracking denials
    • Future prevention of denials
  • System/processes: we show you how to follow certain workflows or processes within your PM/EHR system
  • Coding-based training: Customized for your billing staff

 

Our coding tools, knowledge, and experience give your office a solid understanding of proper coding. Our experienced staff can increase your team’s efficiency and knowledge of coding and documentation through personalized training.

  • ICD-10 core essentials of appropriate diagnosis coding and selection
  • E/M – the elements of how to select the proper office visit evaluation and management codes
  • Documentation – Basic documentation requirements and their role regarding coding
  • Additional guidelines – HCPCS, PCT and modifiers
  • Specific Payers’ coding guidelines

(MA+ program, FQHC Billing Program)

Let’s Talk

If you represent a FQHC, please contact us so we can show you how we can enhance your revenue and streamline your operations, so you can best serve America’s underserved and uninsured population.

See how Medusind can work for you

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.

See how Medusind can work for you

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.