Below you’ll find answers to some of our most common FQHC frequently asked questions.
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Below you’ll find answers to some of our most common FQHC frequently asked questions.
No. Our solutions are designed specifically for Federally Qualified Health Centers (FQHCs).
We offer a range of integrated solutions for you and your providers, to help you achieve your financial goals:
- Revenue cycle management. We can manage part or all of your billing and collections, leading to streamlined processes, reduced costs and increased revenue. We can also manage your facility and health plan credentialing, and assist you with contract negotiations to ensure that you receive the best possible reimbursement rates.
- 340B pharmacy solutions. We can help you determine which pharmacy options will enable you to offer your patients access to the medications they need, when they need them, improving both quality of care and your bottom line. We provide in-house pharmacy management or offsite alternatives, as well as site specific formulary and pricing, ongoing monitoring and reporting.
- Practice expansion strategies. We look for growth opportunities, such as expanding your range of services to meet community needs, developing and leveraging partnerships with key organizations or providers, and balancing your patient mix to ensure financial sustainability.
Our head office is located in Tampa, Florida, and we serve clients in several other states including Georgia and Mississippi. We are currently expanding further, so please contact us to see whether our expansion will cover your area.
We don’t offer ‘one size fits all’ solutions, as we understand that all practices have unique requirements. Please contact us to discuss your needs, so that we can provide you with a tailored quote.
We store applications, credentialing worksheets, statements, contracts, CPT codes, reports and other information in an electronic format on a HIPAA compliant secure sever.
Yes. We have implemented a security control framework as per HIPAA guidelines. All employees complete HIPAA certification training annually, and we regularly assess and improve our security control systems and processes.
Revenue Cycle Management
RCM refers to all of the functions you undertake to collect payment for services that you provide to your patients. This broadly includes your policies, processes, procedures, systems, tasks and resources.
Even if you have an internal billing department, it can be difficult to keep up with industry changes and increased volume, which can result in lost revenue. As your patient base grows, engaging a professional RCM company makes financial sense.
We are experts in FQHC billing, and can help you streamline your existing process or implement a more efficient billing solution. We have a pool of FQHC specialists and can scale to meet your needs, which means you can reallocate your team to other tasks, or reduce your headcount. Ultimately, you will benefit from increased collections, reduced overhead costs and improved cash flow.
Yes. We can offer either individual services or a full outsourced solution. However, please note that in our experience, the benefits of outsourcing your end to end RCM process results in much greater financial results.
Credentialing and Contract Support
Credentialing is the process of verifying a provider’s professional credentials, to meet the criteria required to apply for hospital privileges or to become an in-network provider for an insurance company. Typically, this includes verification of your NPI, CAQH, professional licenses, diplomas, certifications, training verification, malpractice history, attestations and professional references.
To become an in-network provider with an insurance carrier, providers must first complete the verification process. Each carrier may have different criteria and processes.
The first step is to complete the relevant organization’s application form and provide all required supporting documentation. It is critical that all documents are accurate, and that they match the application. Your credentials are then verified according to accreditation, regulatory and the relevant organization’s requirements. After the credentials are verified, the application is reviewed by a committee for approval.
Once the completed application form and required documents are submitted, the process usually takes up to 90 days. This timeframe is a guide only, and can be impacted by state and organization requirements.
Yes. We can help you apply for and obtain a group NPI for your new or established practice. We can also help you update or renew your NPI.
Yes. We can complete your application and follow-up with your hospital to ensure that your privileges are granted in a timely manner.
Yes. If you do not have a CAQH number, we can help you obtain one during the credentialing process. We will complete this application for you and ensure that it is submitted correctly to your insurance plans.
After being credentialed, the second step to becoming an in-network provider for an insurance plan is to contract with the insurance carrier. This contract outlines the services covered, reimbursement rates, payments, and other information. Every company requires a separate contract, and it’s important to review your contracts periodically to ensure that you are receiving the best possible rates.
Yes. We will work with you to identify the best plans for your practice in your area. Please contact us today for a personalized quote.
We can handle the credentialing of both your practice and your providers, and help you negotiate your contracts to ensure that you receive the best possible reimbursement rates. We can also suggest plans commonly used in your area.
Accurate provider credentialing is critical, as it makes the difference between getting paid and not. Special attention is needed throughout the credentialing and contracting process, and most small practices don’t have a dedicated credentialing employee.
Credentialing is a complex and specialized field, and it is critical to have accurate provider credentialing – otherwise payers can refuse to make reimbursements, which impacts your revenue. We can reduce this risk by managing your credentialing on an ongoing basis, for new and existing providers.
We can also reduce your overhead by eliminating the need to employ a credentialing specialist in your practice. The cost associated with having an employee on your payroll includes not only their salary but health insurance, retirement, facilities and equipment. If you already have an employee who is responsible for these duties, they can be reassigned to another area of the practice.
We can help you add additional plans that you may not be currently enrolled with, as well as maintain your current information. You should re-attest your CAQH application every 60-90 days and insurance companies will require recredentialing every 18 months.
340B Pharmacy Solutions
The 340B Drug Discount Program is a federal government program that requires drug manufacturers to provide significantly discounted outpatient drugs to eligible organizations, generally those working with underserved communities.
The 340B Program ensures that patients with financial constraints get access to the medications they need, when they need them. Implementing a 340B pharmacy solution will help you stretch your limited resources further, while at the same time improving your patient compliance rates, and can generate new revenue streams for your facility.
We recommend having multiple pharmacy solutions in place, to capture the greatest number of patient prescriptions possible, and maximize the benefits available to you with the 340B Program. We believe the ideal solution is to have an in-house pharmacy or dispensary as well as contracted pharmacies. This enables patients to obtain their medications wherever they prefer (at the Point of Care or their preferred pharmacy), which increases patient compliance as well as your financial benefits.
We understand the perceived barriers to implementing an in-house pharmacy or dispensary – you may be surprised at how little space and upfront cost is actually required! Considering the exponential revenue growth an in-house pharmacy can generate, why not contact us to see whether it’s an option for you?!
We will review your end-to-end pharmacy operations and analyse your existing patient demographics, to identify ways to increase your capture rates. This may include adding new specialty drugs to cater for a specific demographic, launching patient programs designed to make it easy to fill their prescriptions, or even helping you establish an in-house pharmacy, if not already in place.