How FQHC RCM helped a health center increase collections 29%

The coding backlog at Care Alliance was aging toward the filing limit. Care Alliance is one of six FQHCs Coronis Health supports in Ohio and its third partner on that OCHIN Epic installation. When Coronis Health took on FQHC medical billing after charge capture—claim submission, denial work, payment posting and accounts receivable—coding and coding-error review stayed with Care Alliance’s internal staff and providers.

Pending charges that needed a certified coder review kept accumulating faster than the team could clear them. Even with steady effort from internal staff, the list grew, and by the end of the fiscal year pending charges had reached a high of over eight days—putting revenue at risk of aging past the filing limit.

Coronis Health connected its coding resources to the billing work already underway—coding that had stayed with Care Alliance’s own staff. With the backlog climbing, the team stepped in and reviewed the pending inventory for what was holding claims up. Its coders know the nuances across FQHC specialties, so both sides expanded the partnership and folded coding into the FQHC billing services already in place.

Diagnosis and modifier fixes — The team completed diagnosis edits and handled modifier additions and corrections so charges held for coding could move on to claim submission.

Uncoded note review — Coders reviewed uncoded notes to determine whether a billable service was performed and documented before those charges were billed.

A defined resolution workflow — Coronis Health and Care Alliance built a defined workflow to resolve claims on time and bring down aged accounts receivable.

Provider-specific feedback — Coders gave providers specific feedback on their documentation to reduce coding errors and help mitigate future returns.

Higher collections and a shorter backlog followed. The coding backlog fell to one day, down from a high of over eight. Accounts receivable came down by more than 19%, and collections rose 29%—steadying FQHC reimbursement for these services. Care Alliance was also recognized on its system host’s most recent client scorecard.

• Accounts receivable: reduced by more than 19%
• Coding backlog: cut to one day, from a high of over eight
• Collections: increased 29% across the engagement
• Recognition: noted on the system host’s most recent client scorecard