FQHC Billing Service
Empowering Providers, Enhancing Care, Elevating Revenue.
Imagine this: Your front desk team just processed a Medicaid claim for a prenatal visit and a mental health counseling session. But did the billing codes capture both? For many FQHCs, the answer is a nervous “maybe.”
At Scionis RCM, we’ve spent years dissecting the unique DNA of FQHC billing—the PPS rate nuances, the sliding fee minefields, the ever-shifting compliance rules. While we’re new to your story, we’re not new to yours. Here’s how we turn billing chaos into clarity, so your center can focus on what it does best: healing communities.
The math behind Prospective Payment Systems can stump even seasoned billers. Miss one encounter or miscalculate a wrap-around service, and you’re leaving thousands on the table.
Our Approach:
Decoding the Formula: We translate PPS rules into actionable steps—like ensuring every qualified encounter (T1015) and ancillary service (HCPCS S02) is tracked and billed.
Compliance Safeguards: Automated checks for double-billing risks and HRSA guidelines, so audits become checkmarks, not crises.
A denied claim for a diabetic patient’s glucose screening isn’t just a revenue loss—it’s a gap in care. Yet 1 in 5 FQHC claims are denied for avoidable reasons: outdated modifiers, missed prior authorizations, or eligibility hiccups.
How We Fight Back:
Precision Coding: Our certified coders cross-reference every ICD-10, CPT, and FQHC-specific code like detectives. Think of us as your claims’ quality control.
Denial Autopsy: Every rejection gets dissected. Was it a telehealth coding error? A missed sliding fee adjustment? We find the pattern and plug the leak.
Your team didn’t sign up to argue with insurers over modifier 25. But when turnover hits, coding expertise walks out the door.
Our Answer:
Extension of Your Team: We handle prior auth follow-ups, denial appeals, and Medicaid re-submissions so your staff can breathe.
No Training Headaches: Our specialists stay updated on CMS changes, Medicare Advantage snags, and state-specific Medicaid quirks—you get expertise on demand.
Did your provider document that 15-minute nutrition counseling during a child’s wellness visit? What about transportation for a senior’s vaccine appointment? These “small” misses add up to six-figure annual losses.
How We Shine a Light:
Service Capture Audits: We identify underbilled areas—behavioral health integrations, chronic care management, dental screenings—and build workflows to track them.
Sliding Fee Simplicity: Streamline income verification and fee adjustments without adding paperwork for your front-line staff.
Built for FQHCs, by FQHC Experts: Our team includes former FQHC billing managers who’ve wrestled with the same HRSA reports and Medicaid MCO headaches you face daily.
Transparency First: Real-time dashboards show exactly where your revenue stands—A/R days, denial trends, PPS reimbursement rates—no sugarcoating, no surprises.
Fast, Sustainable Fixes: We prioritize low-effort, high-impact changes. Example: One workflow tweak for a client* recovered $4,800/month in missed dental code billing.
FQHCs don’t need another vendor—they need a partner who speaks their language. We may not have a decade of client logos to show off, but we have something better: razor-sharp focus on your world. The world where every dollar reclaimed means more vaccines, more dental visits, and more lives steadied in turbulent times.
Q1: “How can we avoid underbilling under PPS rates? It feels like we’re always leaving money on the table.”
A: PPS rate errors often stem from missed ancillary services (e.g., behavioral health integrations, transportation) or misapplied encounter codes. At ScionisRCM, we:
- Audit 100% of encounters to ensure wrap-around services are coded (e.g., HCPCS S02 for mental health).
- Use proprietary software to auto-calculate PPS reimbursements, flagging underbilled visits.
Example: One workflow adjustment helped a client* identify $12k/month in unbilled chronic care management services.
Q2: “Our denials are skyrocketing. What’s the #1 mistake FQHCs make?”
A: Eligibility oversights. Outdated patient data or missed sliding fee verifications trigger 35% of denials. We:
- Deploy real-time eligibility checks with Medicaid/Medicare systems.
- Train your team (at no extra cost) on denial “hotspots” like telehealth modifiers or prior authorization gaps.
Q3: “We’re short-staffed. How do you handle turnover without disrupting our workflow?”
A: Our certified FQHC billing specialists act as your back-office team. We:
- Assign a dedicated account manager who knows your state’s Medicaid nuances.
- Provide 24/7 support for urgent issues (e.g., claim resubmissions, compliance alerts).
Q4: “How do you capture services we didn’t even know were billable?”
A: Through granular audits. For instance, many FQHCs miss:
- Smoking cessation counseling during routine visits (CPT 99406).
- Group diabetes education sessions (HCPCS G0108).
We build custom coding checklists for your providers to document every billable minute.
Q5: “Aren’t all RCM vendors the same? Why choose ScionisRCM?”
A: Generic vendors lack FQHC-specific expertise. We’re different because:
- FQHC-Only Focus: Our tools and training are built exclusively for community health centers.
- Compliance First: Automated safeguards prevent double-billing risks and HRSA audit triggers.
- No Long-Term Contracts: Prove our value risk-free—85% of partners see ROI within 90 days.
Q6: “What if we’re already working with another billing company?”
A: Let’s audit your current performance. We’ll benchmark metrics like:
- Denial rates (industry average: 15-20%; our partners average 6-8%).
- A/R days (we aim for <45 days).
- Uncaptured service revenue (often 10-15% of total billing).
No pressure—just clarity.
Q7: “How do you stay updated on changing FQHC regulations?”
A: Our team includes ex-FQHC billing managers and compliance officers. We:
- Monitor CMS updates, HRSA bulletins, and state Medicaid changes daily.
- Host quarterly webinars for clients on trending issues (e.g., 2024 telehealth extensions).
Q8: “What’s the first step to working with ScionisRCM?”
A: A free, no-strings billing assessment. We’ll:
- Analyze 60 days of claims to pinpoint revenue leaks.
- Provide a customized roadmap to reduce denials and boost reimbursements.
No sales pitches—just actionable insights.
Final Note: Your FQHC’s financial health shouldn’t depend on guesswork. At ScionisRCM, we blend regulatory mastery with relentless advocacy for your mission.
Ready to Fix What’s Broken? Contact ScionisRCM today. Let’s turn your billing challenges into your greatest success story.
Unlock your healthcare organization's true financial potential with Scionis RCM. We specialize in streamlining complex revenue processes, recovering lost revenue, and optimizing cash flow. With our expertise, you can focus on delivering exceptional patient care while we enhance your financial efficiency and growth.
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