Case Study: FQHC Revenue Cycle Assessment and Improvement

Case Study: FQHC Revenue Cycle Assessment and Improvement


Avanza capabilities at work: Strategic Planning, Feasibility Assessment, Program Design and Implementation, Operations, Evaluation

"I am grateful to Avanza for their dedication and hard work. Their personnel took the time to help us with the transition to a new billing company and identifying opportunities to improve our RCM. Their industry knowledge and experience was invaluable."


SITUATION

A federally qualified health center (FQHC) was struggling with its revenue cycle management. The organization was unsure about whether its commercial contract rates were appropriate and if terms were fair. Data on collections was lacking. The center was unaware of the credentialing status for many of its providers. The FQHC had also made the decision to change its billing and collections company.


ENGAGEMENT

Avanza Healthcare Strategies was brought in by the FQHC's leadership to review and assist with identifying opportunities to improve the organization's revenue cycle processes and procedures, including payer relations and contracting, and assist with the transition to and implementation of the new billing company.


HOW WE HELPED

  • Conducted comprehensive discussions with leadership from the FQHC, billing providers and commercial payers.
  • Reviewed commercial contracts, which included analyzing commercial reimbursement rates and identifying and recommending changes and opportunities for improvement to the contracts and negotiated rates.
  • Ensure providers were properly credentialed by the commercial payers and considered "in network" with those payers.
  • Created a matrix identifying payer terms and conditions that would benefit the operations of the organization.
  • Conducted an in-depth assessment of billing and collections processes.
  • Performed a gap analysis and developed a list of projects not completed by the current billing company, the status of each project and recommendations for how the FQHC should handle resolving any identified issues.
  • Identified more than $900,000 in unbilled claims and worked with payers to submit unpaid claims for processing.
  • Assisted in the development of the FQHC revenue cycle management transition plan outlining responsibilities for each party involved: the FQHC and two billing providers.
  • Temporarily served in a billing manager role during the transition to the new billing company.


OUTCOME

Avanza generated a comprehensive analysis report and shared the key elements with the FQHC's leadership. The recommendations were accepted and implemented.

Avanza also ensured the transition to the new billing company was successful and instituted processes to improve upon previous billing and collections efforts. The FQHC has collected hundreds of thousands of dollars from previously unpaid claims and substantially reduced its average A/R days.