5 success strategies every Federally Qualified Health Center needs to know

5 success strategies every Federally Qualified Health Center needs to know

Federally Qualified Health Centers (FQHCs) face unique challenges such as lack of resources, limited funding, disparate workflows and more, which can inhibit the ability to get paid faster and more accurately.

Recent data reveals FQHCs experienced a 26% decline in patient visits during the pandemic. Because on average a majority of an FQHC’s revenue comes from patient care, this has created a particularly challenging fiscal environment for most centers.

Per recent findings, FQHCs have also seen a surge in telehealth usage due to quarantine restrictions, with telephone visits comprising 48.5% of their services at the height of the pandemic. Between the demand for new equipment to facilitate virtual care and the need to recoup losses caused by COVID-19, centers are hard at work on new strategies to steady cash flow and better assist their patients.

Leveraging technology and a partner with revenue cycle expertise can help your FQHC reduce denials, administrative burdens and manual workflows to maximize reimbursements. Below, we’re taking a look at five strategies you can start implementing today to help achieve those goals.

Strategy: uncover more coverage + empower patients with stronger eligibility tech

Result: 3x reduction in eligibility-related denials

If you’re like most health centers, your patient engagement staff probably spends a serious amount of time verifying accurate eligibility and benefit details. Despite all this effort, about 30% of denials are the result of pre-service errors. How can you combat these challenges?

  • Encourage informative patient financial conversations and boost patient satisfaction with real-time, multi-payer eligibility to find accurate patient coverage details.
  • Engage and empower your patient population by keeping them informed and educate them on their benefits and options.
  • Utilize intuitive cloud-based technology and easy-to-use tools to create a simple user workflow.
  • Use advanced tools to identify any active coverage on self-pay patients where it may otherwise be unknown.

Strategy: Work with a partner to prioritize + prevent denials with automation

Result: 55% fewer denials than previous vendors

Did you know more than 75% of health centers rank denial management as their greatest challenge within the revenue cycle? Without the right tools, managing denials and compiling appeal packages can slow cash flow and take your team away from higher-value tasks. No two denials are the same, and your team needs to submit appeals quickly and efficiently. Here’s how you can use stronger automated solutions to prioritize and prevent denials.

  • Reduce avoidable write-offs by using root-cause reporting to address upstream drivers of denials.
  • Improve your workflow with simplified tools, allowing you to prioritize the right denials with the right resources.
  • Use measurable KPIs to assess staff productivity and effectiveness.
  • Eliminate the paper appeals process to accelerate appeal submissions and tracking.
  • Automate and simplify your denials and appeals, allowing you to capture all potential reimbursement.

Strategy: accelerate reimbursement with precision accuracy + visibility tools

Result: up to 30% increase in cash flow

Claim management is one of the most demanding parts of the revenue cycle due to deep-rooted manual processes, a lack of visibility into payer data and other challenges. Collecting from patients is another significant challenge, as more financial responsibility falls to them.

It is critical to implement the right tools and resources across your entire rev cycle to help prevent rejections and denials before they happen, automate claim monitoring, streamline appeals and attachments, utilize multiple patient payment methods and work both commercial and government claims in one place.

  • Start at the beginning. Check eligibility on every patient and utilize a solution that will ensure you get the most accurate responses. Cash flow improvement requires a different perspective. Your patient engagement staff holds the keys to preventing the most frequent cause of denials.
  • Use a claim-scrubbing engine that will flag errors before the claim is ever submitted to the payer to avoid delays in payments.
  • Automate your claims status activities—don’t waste valuable time by calling payers or going to their websites to search for those details.
  • Stop hunting down information and avoid the pitfalls of process inefficiency. A focus on process improvement and automation can make the difference between a write-off versus a timely appeal and payment.
  • Understand your denials, then plan your staffing. Triage and correctly route denials for optimal prioritization and staff specialization.
  • Automate your appeals process and go paperless. Eliminate manual processes with simplified processes that will auto-populate data and attachments with payer-specific forms.
  • Use comparative analytics to track your progress and measure your success against other health centers like you.

Strategy: streamline workflows and do more with less

Result: 33% increase in productivity

The complexities of rev cycle management can be challenging enough without worrying about multiple vendors supporting each step in the process. Disparate workflows can cause staff inefficiencies and unforeseen delays, making it difficult to accomplish tasks in a timely manner. The ability to process professional, institutional and dental claims in one place can dramatically increase productivity across the board.

  • Choose a platform that allows you to do more with less effort.
  • Transform your workflows by consolidating your claims submission processes through one vendor and one connection.
  • Allocate your resources in new ways with tools and resources that simplify how they manage tasks and activities.

Strategy: automate Medicare claim management + get paid faster

Result: Reduce Medicare AR days by 25-50% in six months

Medicare claims add up to a sizeable payer mix that can significantly influence the financial health of your organization, but they pose their challenges. Submission through your clearinghouse or direct data entry is inefficient, manual claim editing processes are error-prone and a lack of transparency into returned, denied or pended claims can put you at risk of violating timely filing rules.

No better reason to explore ways to automate workflows, achieve Medicare compliance and ultimately get paid more quickly.

  • Implement your Medicare tools, workflows and analytics in one place—no more direct data entry or manual processes.
  • Choose a partner who can offer direct access to Medicare’s FISS system.
  • Implement compliance solutions that ensure you can expedite documentation submissions.
  • Ensure you have the right resources in place to avoid duplicate claim submissions and reduce AR days.

Wrapping it up: planning for success starts with the right strategy

Between staff and resource limitations, FQHCs face unique challenges as they strive to fill a critical role in their communities. That’s why automation and visibility are so vital to their success, not just in day-to-day operations, but in pursuit of their greater mission to enrich the lives of their patients.

Are you and your FQHC looking to fully transform your rev cycle with a new approach? With Waystar you can achieve:

  • 3x reduction in eligibility-related denials
  • Up to 30% increase in cash flow
  • 33%+ increase in productivity
  • 55% fewer denials than previous vendors
  • Reduce Medicare AR days by 25-50% in six months

Want to learn more? Click here to learn how Waystar tailors solutions for FHQCs to help them reduce denials, accelerate reimbursement and elevate their patient experience.

About Author


Extra Grunge Rusty Pattern Background, vignetted


Get the latest in RCM and healthcare technology delivered right to your inbox.

Sign up