FQHC Revenue Cycle Management, Credentialing & Enrollment

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.