Making the move to an outside vendor for your community health center's (CHC's) billing needs can be a difficult decision. CHCs are truly the hearts of the communities which they serve. Not only do they provide quality healthcare to underserved populations, they provide much-needed employment opportunities as well. Many CHCs take great pride in providing jobs to their local communities and rightfu...
Understanding how to bill services under another provider's National Provider Identifier (NPI) can be confusing at best. While some CHCs do it every day, others avoid it completely, and some only deal with this challenge sporadically, often applying an ever changing assortment of rules or policies that are rarely based on payer contract language or government statute. At PMG we hear about thi...
Wednesday, 12 July 2017 16:51

Secrets for Winning the A/R Battle at Your CHC

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At month's close, Community Health Center (CHC) executives across the country brace themselves as they review the status of their accounts receivable (AR). Dollars owed to the center for services provided, sitting there, just out of reach. Some may meet with billing staff in an effort to get those claims approved; others may just sigh and resign themselves to writing it all off. At PMG, we see tha...
To many in CHC leadership, these three topics can be confusing. To maximize reimbursement, while staying compliant with governmental regulations and payer contractual language, it behooves CHC fiscal and RCM (revenue cycle management, a.k.a., billing) team leaders to peruse this article for a brief overview. NPI OverviewBefore we even begin to delineate definitions of terms here is a quick review...
Congressional consternation continues in Washington D.C. Too many options from too many interest groups makes it difficult to find commonality to meet the needs of all Americans. Perhaps that is the Achilles' Heel; i.e., no one plan will meet the needs of all. In the end, the most at risk populations... the poor, marginalized, and those in healthcare provider shorter areas (HPSA)... remain the mos...
Too many CHCs are befuddled when it comes to understanding how to bill services under another provider's National Provider Identifier (NPI). Some CHCs do it every day, others never, and some sporadically while applying different rules or policies often founded in folklore or fantasy vs. payer contract language or government statute. Let's set the record straight on these terms, what they mean, and...
2016 was tumultuous to say the least, with the most divisive U.S. election in modern history topping the list. Despite the dire predictions of some pundits, the world didn't end the day after the election. The sun still came up, and over 75,000 patients were seen at federally qualified health centers (FQHCs) across the United States. But make no mistake — in the next two years, our market will e...
Monday, 19 September 2016 16:10

Top 5 Reasons PPS G Codes Need Code Expansion

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Coding is a complex topic. So confusing is it that too many in CHC leadership fail to sometimes grasp nuances essential to broadly capturing the full breadth and scope of all services rendered. This misstep results in undervaluation of actual services rendered, diminishes staff morale due to their inability to demonstrate the volume and intensity of work done, and (most obviously) mitigates full p...
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