September 11, 2017
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 rightfully so.
On the other hand, Medical billing has always required a highly specialized set of skills, and in the last few years, we’ve seen a steep increase in complexity particularly with CHC’s. The decision to choose an outside vendor for your revenue cycle management provides better outcomes is often a vital first step in improving the fiscal health of your community health center.
You may think that choosing to work with a revenue cycle management company means that you will have to eliminate billing staff but we find that is not always the best return on investment. PMG believes your staff is the best asset that you have to impact results that affect revenue cycle, while not having to deal with the complexities of revenue cycle management all alone. We have moved away from the traditional idea of outsourcing and moved to a more flexible model we like to consider co-sourcing. We know that your team understands the ins and outs of your center and our team brings our extensive revenue cycle knowledge to the table. This model has proven effective, allowing for a stronger revenue cycle while still keeping your team on board.
The following are all revenue enhancing positions that our client partners have used to redeploy staff when partnering with PMG. Allowing your staff to find a specific niche within the revenue cycle not only benefits your center’s cash flow but also creates opportunities for staff to expand their knowledge and find a path for career growth.
One of the most significant reasons why claims are denied is due to eligibility. We find that most of our clients, prior to partnering with PMG, had a higher percentage of all claims denied for eligibility issues. Many of these health centers have redeployed billing staff to check eligibility prior to a patient’s appointment. This practice has decreased eligibility denials significantly. Getting patients in the right payer class early on, means higher revenue and increased cash follow. In addition, staff can be redeployed to the front desk when a patient checks-in and eligibility has not been verified prior to the patient’s visit.
Self-Pay is one of the most difficult revenue streams for a health center to collect. Often times, balances are written off and valuable revenue is lost. Many of the health centers we have worked with have redeployed billing staff to self-pay and/or billing counselor positions, to help collect self-pay balances and manage sliding fee schedules.
Credentialing/ Provider Enrollment
Getting paid from third party payers requires that providers are credentialed with each payer and their credentials are maintained. Another category of significant denials and significant accounts receivable issues is, credentialing. Community health centers have found that by dedicating resource to credentialing, they have decreased the high percentage of denials from third party payers.
Health Center Expansion
As community health centers expand services, hours and locations. The need for experienced front office staff increases. To that end many of our clients who have made the decision to co-source their revenue cycle management are redeploying billing staff in areas that would normally require the addition of new staff. Billing staff are familiar with the health center policies and procedures and require minimal onboarding and training to serve the expansion needs of the center.
We believe that as the revenue cycle continues to become more complex that you will see more and more of this hybrid model of revenue cycle management. Your billing vendor should not feel like an outside entity that is here to take over. We believe that it should be a true partnership with everyone on the same team. Only then can we ensure that our CHC clients collect every dollar they deserve.