At BCA, we have the distinct pleasure of working with billers, coders, and clinicians from coast to coast. We’ve listened carefully to the struggles and needs of each organization and have responded by expanding our offerings. In order to efficiently answer the many questions we receive, we’re using this platform. Please browse the posts below for answers to your common questions and updates to information that is essential to your revenue cycle. If you don’t see your question answered here, feel free to submit it for consideration.
RevU Recent Posts
- Optimizing Contract Negotiations with Payers
Effective payer contract negotiations are essential to ensuring fair reimbursement rates and sustainable revenue streams. By taking a strategic approach to negotiations, organizations can strengthen their financial position and better serve their patient populations. The Importance of Strategic Contracting Payer contracts not only determine reimbursement rates, but also payer requirements for billing, coding, and quality… Read more: Optimizing Contract Negotiations with Payers - Reducing Provider Burnout with Documentation SupportProvider burnout is a growing concern, especially as clinicians face increasing documentation requirements alongside patient care duties. Supporting providers with tools and workflows that reduce the documentation burden can improve morale, enhance care quality, and ensure accurate billing. The Link Between Burnout and Documentation Documentation requirements often contribute significantly to burnout. Providers may feel overwhelmed… Read more: Reducing Provider Burnout with Documentation Support
- Integrating Behavioral Health and MAT ServicesThe integration of behavioral health and medication-assisted treatment (MAT) services into primary care settings offers a dual benefit for FQHCs and RHCs: improving patient outcomes and increasing revenue. However, successful implementation requires careful planning, coding expertise, and staff training. The Case for Integration Behavioral health and MAT services are critical for addressing the complex needs… Read more: Integrating Behavioral Health and MAT Services
- Preparing for Federal Budget CutsFederal budget cuts can pose a significant challenge for FQHCs and RHCs, as they rely heavily on government funding to provide essential services to underserved populations. Preparing for potential reductions in funding is critical to ensuring financial sustainability and continuing to meet patient needs. Understanding the Impact of Budget Cuts Federal budget cuts can affect… Read more: Preparing for Federal Budget Cuts
- Using Data to Drive Revenue Cycle ImprovementsData is one of the most powerful tools for optimizing the revenue cycle. For FQHCs and RHCs, leveraging data effectively can identify inefficiencies, prioritize areas for improvement, and ultimately boost financial performance. Why Data Matters in Revenue Cycle Management Revenue cycle management generates vast amounts of data, from patient demographics to claim outcomes. Analyzing this… Read more: Using Data to Drive Revenue Cycle Improvements
- Streamlining Denial ManagementClaim denials can be one of the biggest obstacles to financial success for FQHCs and RHCs. Denials delay payments and consume staff time and resources to resolve. A proactive approach to denial management is essential for maintaining a healthy revenue cycle and ensuring timely reimbursement. Common Causes of Denials Denials often stem from avoidable issues,… Read more: Streamlining Denial Management
- Improving Front-End Operations for Financial SuccessThe front end of the revenue cycle is often overlooked, but it plays a critical role in ensuring accurate billing and timely reimbursement. By optimizing front-end operations, FQHCs and RHCs can significantly improve their financial performance. Key Front-End Processes Common Front-End Challenges Metrics to Monitor for Front-End Success Steps to Optimize Front-End Operations The Financial… Read more: Improving Front-End Operations for Financial Success
- Maximizing Reimbursement for Telehealth ServicesTelehealth has emerged as a critical service offering for FQHCs and RHCs, particularly in the wake of the COVID-19 pandemic. However, navigating the complexities of telehealth reimbursement can be challenging, especially as federal and state regulations continue to evolve. The Importance of Telehealth for FQHCs and RHCs Telehealth services allow providers to expand access to… Read more: Maximizing Reimbursement for Telehealth Services
- Leveraging AI in Revenue Cycle ManagementArtificial intelligence (AI) has become a buzzword in healthcare, offering solutions to improve efficiency, accuracy, and productivity. For FQHCs and RHCs, leveraging AI in revenue cycle management can streamline workflows and enhance financial performance. However, not all AI solutions are created equal, and understanding their strengths and limitations is key to maximizing their potential. AI… Read more: Leveraging AI in Revenue Cycle Management
- Navigating Value-Based Care ModelsValue-based care is transforming how FQHCs and RHCs operate, moving away from fee-for-service models to reimbursement tied to outcomes. While the shift promises better patient care and financial rewards, it also presents unique challenges that must be navigated for financial stability. Understanding Value-Based Care VBC incentivizes healthcare providers to improve the quality of care they… Read more: Navigating Value-Based Care Models
- Enhancing Billing and Coding AccuracyBilling and coding accuracy is critical for ensuring that services rendered translate into appropriate reimbursement. For FQHCs and RHCs, even minor errors can lead to claim denials, compliance issues, and significant revenue loss. Accurate billing and coding ensure the financial health of your organization while safeguarding against regulatory risks. Why Billing and Coding Accuracy Matters… Read more: Enhancing Billing and Coding Accuracy
- Understanding Revenue Cycle FundamentalsThe revenue cycle is the backbone of financial sustainability for FQHCs and RHCs. It encompasses all administrative and clinical functions that capture, manage, and collect patient service revenue. However, the revenue cycle remains fraught with inefficiencies and missed opportunities for many organizations. Key Components of the Revenue Cycle The revenue cycle begins with patient registration… Read more: Understanding Revenue Cycle Fundamentals
- The Role of Coders and Revenue Cycle Management in Reducing ReadmissionsRevenue cycle and coding processes are essential in supporting clinical efforts to reduce hospital readmissions for primary care clinics. Accurate documentation, coding practices, and efficient billing processes ensure patients receive the proper care at the right time, minimizing the likelihood of readmissions. Coding Practices That Contribute to Reducing Readmissions and Improving Outcomes Documenting Social Determinants… Read more: The Role of Coders and Revenue Cycle Management in Reducing Readmissions
- Advanced Strategies to Reduce Readmissions for Quality Management and Medical DirectorsReducing hospital readmissions has become a top priority for quality management and medical directors as the healthcare landscape shifts toward value-based care. A comprehensive approach incorporating innovative strategies, strong care coordination, and process improvements can help prevent unnecessary readmissions and improve patient outcomes. Innovative Strategies for Reducing Hospital Readmissions in Primary Care Patient-Centered Medical Homes… Read more: Advanced Strategies to Reduce Readmissions for Quality Management and Medical Directors
- Key Strategies to Reduce Readmissions in Primary CareReducing hospital readmissions is a critical goal for primary care providers as it improves patient outcomes, lowers healthcare costs, and enhances satisfaction. Primary care teams can play a vital role in minimizing readmissions by focusing on care coordination, follow-up, and transitional care management (TCM) programs. Strengthen Care Coordination and Follow-Up:Poor communication between healthcare providers during… Read more: Key Strategies to Reduce Readmissions in Primary Care
- Ensuring Data Integrity in Coding, Documentation, and Quality ReportingData integrity in coding and documentation is vital for quality improvement and value-based reimbursement. Coders and quality teams maintain data accuracy, impacting patient care and financial outcomes. This post covers best practices for ensuring data accuracy, the importance of coder-quality team collaboration, and steps to improve data quality. Ensuring Data Accuracy and Integrity in Coding… Read more: Ensuring Data Integrity in Coding, Documentation, and Quality Reporting
- The Critical Role of Data Integrity in Achieving Quality and Value-Based GoalsUnderstanding how data accuracy affects quality goals, compliance, and reimbursement is essential. This post explores how data integrity drives quality improvement goals, supports value-based care success, and ensures reliability across clinical and financial systems. The Role of Data Integrity in Achieving Quality Improvement Goals High data integrity is essential to achieving quality improvement goals. Without… Read more: The Critical Role of Data Integrity in Achieving Quality and Value-Based Goals
- Data Integrity in Quality Improvement: Ensuring Accuracy from Capture to ReportingData drives quality improvement in healthcare. Accurate, reliable data ensures meaningful insights, supports compliance, and enhances patient outcomes. Data integrity is crucial in quality improvement, best practices for ensuring accuracy, and how quality teams can collaborate with IT and clinical teams to maintain data integrity throughout the reporting process. The Role of Accurate Data Capture… Read more: Data Integrity in Quality Improvement: Ensuring Accuracy from Capture to Reporting
- Compliance Meets Quality: Practical Strategies for Coders and RevenueCompliance with coding standards is essential for accurate reimbursement and quality improvement. This post explores the intersection of compliance and quality in coding practices, how to ensure adherence to regulatory standards while supporting quality outcomes, and practical steps for balancing compliance with quality goals. The Intersection of Coding Compliance and Quality Improvement in Primary Care… Read more: Compliance Meets Quality: Practical Strategies for Coders and Revenue
- Medicare Annual Wellness Visits, Nurses, and FQHCsCan a Medicare Annual Wellness Visit Be Performed by a Nurse Alone? For Federally Qualified Health Centers (FQHCs), the Medicare Annual Wellness Visit (AWV) offers an opportunity to deliver comprehensive preventive care while also receiving enhanced reimbursement—around 137% higher than standard Medicare visits. However, many clinicians wonder if these visits can be performed by a… Read more: Medicare Annual Wellness Visits, Nurses, and FQHCs
- Navigating Compliance and Quality: A Guide for Medical DirectorsBalancing compliance with quality improvement can be challenging, particularly in resource-constrained settings like Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). This post delves into strategies for aligning these two areas, maintaining regulatory compliance while driving continuous quality improvement, and simplifying processes for clinicians. Strategies for Balancing Compliance with Quality Improvement Goals Striking… Read more: Navigating Compliance and Quality: A Guide for Medical Directors
- Navigating the Intersection of Compliance and Quality: A Collaborative ApproachQuality improvement and compliance are critical but often siloed areas in healthcare. By fostering collaboration between quality and compliance teams, organizations can ensure they meet regulatory requirements while enhancing patient outcomes. Let’s explore how these teams can work together to improve care, key compliance areas impacting quality, and strategies for streamlining these processes efficiently. Collaborating… Read more: Navigating the Intersection of Compliance and Quality: A Collaborative Approach
- Maximizing Value-Based Incentives Through Revenue Cycle AlignmentCoding and revenue cycle teams ensure clinics meet value-based quality measures. Today, we’ll outline best practices for coding that target value-based incentives, the revenue cycle’s role in meeting quality standards, and practical steps for coders to support value-based initiatives. Coding Practices That Align with Value-Based Incentives and Improve Reimbursement Accurate coding is essential for meeting… Read more: Maximizing Value-Based Incentives Through Revenue Cycle Alignment
- Financial and Clinical Quality Improvement Alignment for Value-Based Care IncentivesFinance and clinical leadership in healthcare play an integral role in aligning quality improvement (QI) with value-based incentives. Let’s dive deeper into exploring strategies for linking QI initiatives to financial goals, selecting quality metrics that improve financial performance, and using tools to streamline clinician workflows for capturing quality measures. Aligning Quality Improvement Efforts with Financial… Read more: Financial and Clinical Quality Improvement Alignment for Value-Based Care Incentives
- Aligning Quality Improvement with Value-Based IncentivesIn today’s healthcare landscape, quality improvement (QI) initiatives are critical for meeting value-based payment incentives. For most clinics, primarily Federally Qualified Health Centers (FQHCs), aligning these efforts with key performance standards can improve care and financial stability. In this post, we’ll cover how to design QI initiatives that support value-based payment goals, how eCQM (electronic… Read more: Aligning Quality Improvement with Value-Based Incentives
- Coding and Revenue Cycle Management for Social Determinants of Health (SDoH)Incorporating social determinants of health (SDoH) data into clinical documentation is key to ensuring value-based care aligns with actual patient needs. This process supports accurate reimbursement and enhances quality scores for coding and revenue cycle teams. Today, we cover how to code SDoH accurately, how to collaborate across departments to optimize SDoH capture, and best… Read more: Coding and Revenue Cycle Management for Social Determinants of Health (SDoH)
- Advanced Strategies for Integrating Social Determinants of Health (SDoH) in Primary Care for Medical Directors and Quality ManagersIntroductionIncorporating social determinants of health (SDoH) into care is critical yet complex for medical directors and quality managers. Integrating SDoH data drives quality improvement, aligns with managed care goals, and fosters patient trust and engagement. Today, we’ll explore actionable strategies that ensure SDoH data directly impacts quality metrics, care planning, and patient outcomes. Addressing SDoH… Read more: Advanced Strategies for Integrating Social Determinants of Health (SDoH) in Primary Care for Medical Directors and Quality Managers
- Integrating Social Determinants of Health (SDoH) in Primary Care for Quality ImprovementSocial determinants of health (SDoH) – the social, economic, and environmental factors influencing patient health – significantly shape healthcare outcomes. In primary care settings, addressing SDoH can dramatically improve the quality of care by identifying and reducing barriers that patients face. Let’s explore how clinics can locate and capture SDoH data, tools to integrate this… Read more: Integrating Social Determinants of Health (SDoH) in Primary Care for Quality Improvement
- How Quality Managers and Finance Teams Can Leverage Documentation for Quality Reporting SuccessThe quality of clinical documentation directly influences patient outcomes and a healthcare organization’s financial health, regardless of the reimbursement model. For quality managers and finance teams, ensuring that documentation supports accurate quality reporting is essential for securing reimbursements, avoiding penalties, and maximizing financial incentives. Strong documentation practices are more than just good habits—they are the… Read more: How Quality Managers and Finance Teams Can Leverage Documentation for Quality Reporting Success
- The Critical Role of Clinician Documentation for Medical Directors and CodersClinicians have spent years in medical school, residency, and training to focus on one thing—caring for patients, not documenting or coding that care. But the reality of daily life in primary care is documentation and lots of it. For many clinicians, clinical documentation demands can feel overwhelming, and coding might seem like a foreign language.… Read more: The Critical Role of Clinician Documentation for Medical Directors and Coders
- Connecting Clinician Documentation to Quality ReportingAccurate clinical documentation is more than a regulatory requirement; it is the cornerstone of quality reporting that fosters care improvement and financial success. Understanding the connection between documentation and quality metrics can make all the difference in a healthcare organization’s ability to meet performance targets and avoid penalties. Today, we’ll explore how clinicians can enhance… Read more: Connecting Clinician Documentation to Quality Reporting
- Leveraging Patient Input as Clinicians and Quality TeamsMany healthcare organizations face the unique challenge of maintaining high-quality care while effectively managing resources. Patient feedback is crucial for navigating this balance, providing insights that can guide quality improvement initiatives and align with managed care goals. This post explores in-depth strategies for developing KPIs based on patient insights, understanding how feedback impacts care quality, and… Read more: Leveraging Patient Input as Clinicians and Quality Teams
- Patient Input for Quality EnhancementAlthough sometimes viewed as another item to be checked off a compliance list, patient feedback has emerged as the cornerstone for enhancing the quality of care. Prioritizing patient input can lead to targeted improvements, greater patient satisfaction, and better health outcomes. In today’s post, we’ll look at practices for collecting patient feedback, how to turn surveys… Read more: Patient Input for Quality Enhancement
- The FINAL installment of our 3-part OB diagnosis coding webinar series takes place tomorrow!Sharpen your skills in OB-specific coding during our last session of this series. Perfect for coders, billers, and healthcare professionals working in OB care, the series concludes with practical coding exercises to enhance attendees’ coding skills. Register now and secure your spot: https://www.bcarev.com/education/webinar-series-ob-diagnosis-coding/
- Aligning Coding and Quality Improvement Initiatives in Primary CareAccurate documentation and coding are more than just administrative tasks—they are critical components of quality care. Coders play a vital role in ensuring that clinical documentation is correctly translated into codes that reflect the complexity of patient care, directly impacting quality metrics and compliance with value-based care models. For coders to succeed in this mission,… Read more: Aligning Coding and Quality Improvement Initiatives in Primary Care
- Financial and Operational Benefits of Quality-Focused Leadership in Primary CareFostering a quality-driven culture in primary care has substantial financial and operational benefits. First and foremost, a culture of quality reduces errors and inefficiencies, leading to significant cost savings. When organizations prioritize improving quality, they streamline workflows, eliminate unnecessary procedures, and reduce the need for costly corrective measures, ultimately enhancing resource allocation and reducing overhead… Read more: Financial and Operational Benefits of Quality-Focused Leadership in Primary Care
- Building a Quality-Focused Culture in Primary CareAs we see more clinics transitioning to value-based care models, the quality of patient care is more critical than ever. Creating a culture that consistently delivers high-quality care requires more than just a commitment from medical staff. It calls for strong, effective leadership that prioritizes quality improvement at every level of the organization. Leaders must… Read more: Building a Quality-Focused Culture in Primary Care
- PCMH Recognition to Improve Patient Outcomes: Medical Directors and Quality TeamsMedical and quality directors are important in promoting clinical and operational excellence. Patient-Centered Medical Home (PCMH) recognition provides a chance to transform care delivery, prioritize patient engagement, and achieve high-quality outcomes. How can PCMH be used as a framework for value-based care? Let’s discuss the advantages of adhering to PCMH standards and the strategic actions… Read more: PCMH Recognition to Improve Patient Outcomes: Medical Directors and Quality Teams
- Leveraging Patient-Centered Medical Home (PCMH) Recognition for Quality ImprovementClinics and healthcare providers are always seeking ways to enhance quality outcomes and patient satisfaction. The Patient-Centered Medical Home (PCMH) recognition offers a comprehensive, patient-focused approach that prioritizes care coordination, patient engagement, and improved health outcomes. PCMH certification is not just a milestone for quality care; it is a transformative process that reshapes the dynamics… Read more: Leveraging Patient-Centered Medical Home (PCMH) Recognition for Quality Improvement
- Engaging Providers in Value-Based Care: A Financial Perspective for Revenue Cycle TeamsFor finance teams and revenue cycle management, the transition to value-based care (VBC) doesn’t just affect clinical outcomes—it directly impacts billing accuracy, revenue, and the organization’s overall financial health. To succeed in VBC, revenue cycle teams must work closely with clinicians to improve documentation, ensure accurate coding, and leverage financial incentives tied to quality metrics.… Read more: Engaging Providers in Value-Based Care: A Financial Perspective for Revenue Cycle Teams
- Engaging Providers in Value-Based Care: A Guide for Medical Directors and CliniciansThe shift to value-based care (VBC) is one of the most significant changes in healthcare delivery today. For medical directors and clinicians, it’s not just about managing day-to-day patient care but about adapting to new models and prioritizing patient outcomes over volume. While VBC can seem daunting, it offers a tremendous opportunity to improve the… Read more: Engaging Providers in Value-Based Care: A Guide for Medical Directors and Clinicians
- Engaging Providers in Value-Based Care: A Roadmap for Quality TeamsIn today’s healthcare environment, we all know how challenging it can be to get clinicians fully on board with value-based care (VBC). The transition from volume-based models can feel overwhelming, especially when integrating new workflows and meeting performance metrics. However, our quality teams play a critical role in guiding providers through this process—creating an atmosphere… Read more: Engaging Providers in Value-Based Care: A Roadmap for Quality Teams
- Optimizing Quality and Revenue Cycles with Population Health DataFor quality and revenue cycle managers, leveraging population health data to close care gaps and enhance revenue cycle processes is essential to meeting value-based care goals, improving patient outcomes, and maintaining financial sustainability. Population health management is increasingly important in primary care, especially for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). This… Read more: Optimizing Quality and Revenue Cycles with Population Health Data
- Maximizing ROI and Improving Patient Outcomes Through Population Health Management: A Strategic Guide for Financial and Medical LeadershipIn today’s healthcare environment, leaders at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) face a dual challenge: improving patient outcomes while managing resources effectively to achieve financial sustainability. Population health management has emerged as a critical tool for meeting these objectives, allowing healthcare organizations to allocate resources strategically, focus on high-risk patients, and manage chronic conditions while lowering long-term costs.
- Maximizing Patient Outcomes through Population Health ManagementDiscover advanced strategies for using population health data to close care gaps, manage high-risk patients, and improve chronic disease outcomes. Learn actionable steps for building a sustainable population health management program that drives better care and lowers costs.
- Problem List Clean-UpProblem list clean-up is a necessary task, but who has time to devote to it? And even if you clean it up, a quick problem list import from an information-sharing program can have you right back in the mess you just cleaned up! We most often consider this a provider task, but have you given… Read more: Problem List Clean-Up
- Do the new ICD-10-CM codes for obesity classes improve provider comfort with labeling weight disorders?I’ve noted a few trends recently when educating medical professionals on coding guidelines for weight disorders. Many push back on the instructions to pair a weight disorder with a BMI, primarily in the name of provider-patient relationship. This pairing is essential for accurate quality scores and reimbursement, yet it can be seen as a sensitive… Read more: Do the new ICD-10-CM codes for obesity classes improve provider comfort with labeling weight disorders?
- Streamlining Coding Processes Through Quality ImprovementFor coders and revenue cycle managers, quality improvement (QI) is not only about enhancing patient care; it also plays a crucial role in streamlining coding processes and reducing claim rejections. This post explores how quality initiatives can benefit coding practices and improve the efficiency and accuracy of revenue cycle management. How Quality Improvement Efforts Can… Read more: Streamlining Coding Processes Through Quality Improvement
- Aligning Clinical and Operational Quality Initiatives for Better Patient OutcomesAligning clinical and operational quality initiatives is critical for medical directors and quality managers to achieve better patient outcomes. In this article, we’ll explore strategies for integrating quality improvement (QI) across departments and the pivotal role of leadership in fostering a culture of continuous improvement. Importance of Aligning Clinical and Operational Quality Initiatives In healthcare,… Read more: Aligning Clinical and Operational Quality Initiatives for Better Patient Outcomes
- Creating an Integrated Quality Improvement FrameworkIn today’s healthcare landscape, the importance of quality improvement (QI) cannot be overstated. An integrated approach that unites clinical, operational, and administrative teams can significantly elevate patient outcomes, streamline processes, and reduce costs. Developing a unified QI framework is essential for any healthcare organization striving for excellence. Developing a Unified Approach: Integrating Quality Improvement Efforts… Read more: Creating an Integrated Quality Improvement Framework
- Building a Culture of Continuous Improvement in FQHCs and RHCsFostering a culture of continuous improvement is fundamental to the long-term success of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). In these healthcare settings, where resources can often be limited, and the need for quality care is paramount, creating an environment where staff consistently seek better ways to deliver care can significantly… Read more: Building a Culture of Continuous Improvement in FQHCs and RHCs
- Ensuring Compliance and Quality: Best Practices for Conducting Effective Documentation AuditsDiscover essential strategies for effective documentation audits to maintain compliance with regulatory standards and enhance patient care quality.
- Empowering Residents and Medical Students with Essential Coding EducationOne of the most frequent responses we hear when BCA provides coding education to medical professionals is, “I wish I’d had this sooner!” This sentiment reflects a significant gap in medical education: the lack of comprehensive training in coding and documentation.
- Why FQHCs and RHCs Should Care About Risk Adjustment: Taking Comprehensive Care to the Next LevelDiscover the importance of risk adjustment for FQHCs and RHCs. Learn how accurate documentation and financial strategies can enhance patient care, ensure compliance, and achieve financial stability with the help of BCA.
- The Role of Continuous Education in Enhancing Healthcare Delivery in FQHCs and RHCsContinuous education is key to improving healthcare delivery in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Learn how ongoing training leads to better patient care, increased efficiency, and enhanced compliance. Discover valuable resources and strategies to support continuous learning.
- Leveraging Data Analytics to Improve Financial and Clinical Outcomes in FQHCs and RHCsDive into the power of data analytics in healthcare! Learn how FQHCs and RHCs leverage data to boost financial performance and enhance patient outcomes.
- The Importance of Credentialing and Payer Enrollments in Ensuring Quality and Compliance for FQHCs and RHCsDiscover how to optimize credentialing and payer enrollment for FQHCs and RHCs! Ensure compliance, quality care, and cost-effective solutions.
- Optimizing Billing and Coding for Maximum Reimbursement in a Value-Based WorldLearn how to optimize billing and coding for FQHCs and RHCs with best practices, staff training, and practical tools. Maximize reimbursement and ensure compliance in value-based care with expert insight from BCA, Inc.
- Strategies for Successful Value-Based Contracting in FQHCs and RHCsDiscover essential strategies and negotiation tips for value-based contracting in Federally Qualified Health Centers and Rural Health Centers. Learn from expert insights to drive financial and clinical benefits for your organization.
- How Value-Based Care is Redefining Quality Metrics in FQHCs and RHCsDiscover how FQHCs and RHCs can thrive under value-based care by focusing on patient outcomes, preventive care, and chronic disease management. Learn strategies for improving care delivery and achieving financial success.
- Navigating the Shift: Value-Based Care for FQHCs and RHCsExplore the strategic transition from fee-for-service to value-based reimbursement in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Learn how to enhance patient outcomes and ensure financial sustainability with BCA Consulting. #ValueBasedCare #FQHC #RHC #HealthcareTransformation
- Navigating the Financial Future of FQHCs in a Post-COVID-19 Funding EnvironmentAs the financial landscape shifts in 2024 with the diminishing of COVID-19 relief funds, FQHCs nationwide face significant challenges in maintaining financial stability. With inflation demanding increasing wages, rising healthcare costs, and evolving payment trends, finance professionals must adopt strategic budgeting practices to navigate this new reality effectively. The Current FQHC Funding Environment FQHCs have… Read more: Navigating the Financial Future of FQHCs in a Post-COVID-19 Funding Environment
- PHE ChangesWith the public health emergency (PHE) declared to have ended on May 11, 2023, now is the time to update any current policies or practices that may have been implemented in your organization due to Covid-19. One of the most notable updates allows remote communication flexibilities to remain in place for an additional 90 days,… Read more: PHE Changes
- BCA Summary of Diagnosis Coding Updates for April 2023The International Classification of Diseases, Tenth Revision, ClinicalModifications (ICD10CM) is updated April 1st and October 1 st every year. Theseupdates provide opportunities to review the current HIPAA mandated diagnosiscoding guidelines, encourage team members to update the accuracy ofpatient’s chronic problem list and determine necessary educationalopportunities for the entire team This April 2023 update includes 42… Read more: BCA Summary of Diagnosis Coding Updates for April 2023
- Bonnie Hoag ScholarshipIn honor of our founder, Bonnie Hoag, BCA dedicates an annual scholarship award for one worthy recipient to our Comprehensive Coding Education Program (CCEP). The recipient of the Bonnie Hoag Scholarship will receive a full tuition scholarship to our CCEP program that prepares attendees to sit for either their CPC or CCS-P credential. Bonnie’s passion… Read more: Bonnie Hoag Scholarship
- 2023 E/M Guideline Changes WebinarJanuary ushers in significant guideline revisions bringing welcome relief to the current coding drudgery. Clinicians will no longer have to worry whether a patient qualifies for inpatient vs. observation status when selecting their service code. We will see the removal of “bean-counting” requirements for history and exam elements, with guidelines aligning with the outpatient service changes we saw… Read more: 2023 E/M Guideline Changes Webinar
- Comprehensive Coding Education ProgramComprehensive Coding Education Program Elevate your expertise with our comprehensive, self-paced on-demand course tailored for aspiring nationally certified professional coders. Geared specifically toward success in Federally Qualified Health Center (FQHC) settings, this program delves into ICD-10-CM, Current Procedural Terminology (CPT), and HCPCS Level II coding, augmented by the occasional medical terminology, anatomy, and physiology instruction… Read more: Comprehensive Coding Education Program
- How Accurate is Your Diagnosis Reporting?Time to Focus on the Importance of ICD10CM Quality. As you are preparing for your 2023 production data to be analyzed, don’t forget about the importance of accurate ICD10CM reporting. It’s been common knowledge for years that ICD10 codes represent medical necessity for services provided to patients, however, quality reporting has only recently started to… Read more: How Accurate is Your Diagnosis Reporting?
- BCA’s 99211 FactsheetWith a current reimbursement rate of $23.53, it is evident that reporting 99211 can bring additional revenue into your practice. Reporting just five 99211 encounters per week could result in over $6,100 per year. The following guidelines can help assure you maintain compliance and receive the revenue you deserve for the services you may already… Read more: BCA’s 99211 Factsheet
- UDS Quality Measures and HRSA complianceDid you know that one of the compliance pieces of an FQHC is their quality program? Some clinics may refer to this as their CQI or QIQA committee/team. Part of this compliance program is based on accurate data in patient records, which coders can often assist with collecting. This data is then required to be… Read more: UDS Quality Measures and HRSA compliance
- BCA Monday Morning MinutesHave a minute? Check out BCA Monday Minutes! Most recent Monday Morning Minute – Episode 18: Combination Codes
- UDS Reporting UpdateAs UDS reporting deadlines have surfaced, it’s important to know the HRSA Health Center Program FAQs about UDS reporting have recently been updated. Fun Fact: Beginning with the 2023 UDS reporting cycle, HSRA will also accept patient-level report data using Fast Healthcare Interoperability Resources. The following HRSA FAQ page https://bphc.hrsa.gov/datareporting/reporting/faqs is a great resource to visit common… Read more: UDS Reporting Update
- BCA Coding ServicesSimplify Your Coding Practices while Maximizing Revenue At BCA, we always want to stay ahead of our client’s needs. With the ever-changing landscape of the healthcare industry and ongoing demands for FQHCs, we’ve found that there’s an immense need to support our Community Health Center partners with claims coding support. This is due in part to… Read more: BCA Coding Services
- AMA’s CPT 2022 UpdatesThe American Medical Association (AMA) has released the 2022 Current Procedural Terminology (CPT®) code set, which incorporates a series of 24 vaccine-specific codes that are the model for efficiently reporting and tracking immunizations and administrative services against the coronavirus (SARS-CoV-2). The COVID-19 vaccine and administration codes are among 405 editorial changes in the 2022 CPT code set,… Read more: AMA’s CPT 2022 Updates
- BCA No Surprises Act (NSA) Starter ToolkitWith the No Surprises Act (NSA) set to take place for physician services come January 1, 2022, the BCA Team has put together a “No Surprises Act (NSA) Starter Toolkit” designed to help physician offices kick start implementation of this new rule. See the attached documents to get your team started today! Contact Us at… Read more: BCA No Surprises Act (NSA) Starter Toolkit
- No Surprises Act Roundtable EventIn November 2021, the No Surprises Act, was signed into law. This new law is designed to protect consumers from surprise medical bills related to “surprise” and “balance” billing, but what does this mean for our physician practices? We had a great discussion at our roundtable event on 12/1 and continue to learn more about… Read more: No Surprises Act Roundtable Event
- November is American Diabetes Month!According to the American Diabetes Association, one in three people in the United States have prediabetes. Check out their website to be aware how diabetes may affect you as well as some helpful tools to reduce your risk. Check out this simple diabetes diagnosis coding scenario that may occur in the office setting: Follow up… Read more: November is American Diabetes Month!
- October is Breast Cancer Awareness Month: What better time than now to buff up your cancer documentation and reporting?!According to the World Health Organization (WHO), breast cancer is the most common cancer globally (as of 2021) and the second most fatal cancer in women. We encourage those that fall within the screening guidelines to get your mammogram scheduled today. In order to assure appropriate coding for these conditions, it is critical to recognize causes, stages and… Read more: October is Breast Cancer Awareness Month: What better time than now to buff up your cancer documentation and reporting?!
- Managing UDS MeasurementsPeter Drucker famously said, “What gets measured gets managed.” We have spent some time recently exploring UDS Quality Measures, but where do we even begin to look at this data? How can we improve on data if we don’t know where to start? We are going to dive into an amazing place in this post, the world of HRSA data! … Read more: Managing UDS Measurements
- Improving Population Health, One Patient at a TimeWe spend quite a bit of time looking at quality measures. Aside from our UDS reporting, why do we care about quality measures? The days of E&M reimbursement are soon going to be in the rearview mirror and value-based care is where our future lies. Because several of these measures are based on the eCQMs (Electronic Clinical Quality Measures), which are standardized by NCQA, UDS reporting also becomes very important to payers. Currently, many organizations live in… Read more: Improving Population Health, One Patient at a Time
- Telehealth Policy Updates as of 08/23/2021The Center for Connected Health Policy (CCHP) released current Telehealth Policy updates that break down the most common areas of focus right now. These updates include licensing laws, prescribing requirements, reimbursement policies and the best resources to track each. Although we have summarized some of these important updates from CCHP for your reference below, be sure to visit CCHP’s website for… Read more: Telehealth Policy Updates as of 08/23/2021
- Proposed Updates for 2022 Uniform Data Systems (UDS) Reporting: What You Need to Know NowHealth Resources and Services Administration (HRSA) has recently released proposed updates to quality of care measures for 2022. This update is set to align clinical quality measures (CQMs) with the versions of the Centers for Medicare and Medicaid Services (CMS) electronic-specified clinical quality measures (eCQMs) designated for the 2022 reporting period. Data-driven quality improvement efforts and full optimization of electronic health record (EHR) systems are strategic… Read more: Proposed Updates for 2022 Uniform Data Systems (UDS) Reporting: What You Need to Know Now
- Visit for Paperwork: Are these services medically necessary?The following scenario comes across our schedules/lists from time to time and is often reported with an Evaluation and Management (E/M) code (99202-99215) based on time. Example: 44 year old male here for completion of paperwork, scanned copy into chart. ROS: None recorded. Exam: None recorded. A/P: Completion of paperwork and total face-to-face patient time 15 minutes. When a patient presents without complaints, the visit likely does not… Read more: Visit for Paperwork: Are these services medically necessary?
- Coder’s Influence on UDS Quality OutcomesIn FQHCs nationwide, UDS reporting is often thought of once a year and is generally a bad word muttered by CFOs and IT staff. However, it doesn’t have to be so difficult or segregated to such a small reporting team. Many teams are relying heavily on the reporting generated by their EMR system, which may… Read more: Coder’s Influence on UDS Quality Outcomes
- Emphasis on Health Equity in 2021Health equity means ensuring that everyone has the chance to be as healthy as possible. However, factors outside of a person’s control, such as discrimination and lack of resources, can prevent them from achieving their best health. Working toward health equity is a way to correct or challenge these factors. As defined by Executive Order by… Read more: Emphasis on Health Equity in 2021
- Proposed ICD-10-CM ChangesThe ICD-10-CM Coordination and Maintenance Committee met on March 9th and 10th to discuss proposed changes for 10/1/2021. Use this link to access the “Proposal Packet” for details about the requests, https://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm April 9th is the deadline for public comments. The committee will meet again in September. Here are a few highlights of the requested… Read more: Proposed ICD-10-CM Changes
- Best Practice Documentation for NursesQ: Can you provide some information on best practice documentation for nurses when completing orders that are not performed on the date they were ordered? A: This is a great question and the nurses in your clinic may also be a resource to answer your question. While documentation may occasionally be viewed as being burdensome,… Read more: Best Practice Documentation for Nurses
- Undiagnosed New ProblemQ: In the new 2021 E/M Guidelines what constitutes as an undiagnosed new problem? A: CPT defines an undiagnosed new problem with uncertain prognosis as “A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment. An example may be a lump in the breast.”… Read more: Undiagnosed New Problem
- Lost Connection During Audio-Visual Telehealth VisitQ: If a telehealth encounter begins with audio-visual but they must convert to audio-only for the rest of the visit, how do you determine which code to use when the payer accepts the phone code 99441-99442 and the video code is 99212-99215? A: During the current Public Health Emergency, a variety of telehealth policies have… Read more: Lost Connection During Audio-Visual Telehealth Visit
- Two Clinicians Complete One EncounterQ: I have a patient encounter where 2 different providers working in our urgent care clinic completed orders for the same patient encounter. I rarely see this type of documentation and I believe it happened because of shift-change during the encounter. The first provider completed the majority of the visit, ordered a prescription and signed… Read more: Two Clinicians Complete One Encounter
- Established Patient Follows Provider to New ClinicNote: For a new Medicare FQHC patient, see – Medicare FQHC Patients Follow Provider to New FQHC. Q: I have a new provider and several of her patients have followed her to our clinic. Should these patients be coded as new or established at their initial visit in our clinic? A: This question was answered… Read more: Established Patient Follows Provider to New Clinic
- Medicare FQHC Patients Follow Provider to New FQHCNote: This question is specific to the Medicare FQHC new patient definition. For non-Medicare FQHC patients, see – Established Patient Follows Provider to New Clinic. Q: We have recently had providers join our team from other clinics and their patients have followed them. Can you tell me where I can find the guidelines for whether… Read more: Medicare FQHC Patients Follow Provider to New FQHC
- Coding per MDM When Time is DocumentedQ: A provider completed an E/M in 25 min. The documentation supports Moderate MDM, does the service need to be down coded to a 99213 due to the documented time? A: Under the new E/M guidelines, code assignment is per Time or MDM for codes 99202-99215. Time does not need to be documented when coding… Read more: Coding per MDM When Time is Documented
- E/M Coding in Mental HealthQ: My question pertains to the new E/M guidelines in the setting of mental health. Under Amount and/or Complexity of Data for codes 99205 and 99215, it states that 2 of the 3 categories must be met to count Data as Extensive. For services provided in mental health we find we are only meeting 1… Read more: E/M Coding in Mental Health
- Principal Care Management, G2064, G2065, in the FQHC.Q: My physician mentioned there is a new care management code that FQHCs can report for patients with one chronic condition. Is that correct? If so, what is the new code? A: Your physician is most likely referring to codes G2064 and G2065, Principal Care Management (PCM). The codes were new in 2020 but were… Read more: Principal Care Management, G2064, G2065, in the FQHC.
- Personal interpretation of radiology test during an E/MQ: Are there documentation suggestions for a provider’s personal interpretation of an x-ray under the new E/M guidelines when awaiting the radiologist’s formal read? A: This a great question and a topic that requires unambiguous documentation. Otherwise, it may read as though the information was taken from the radiology report or as though the global… Read more: Personal interpretation of radiology test during an E/M
- Documentation of ordered testQ: In order to be able to count a test (ex: lab, x-ray), must the order be documented in the office note or just anywhere in the chart for that day to count? A: Based on review of available payer information including Medicare, the treating/ordering physician or qualified healthcare professional (QHP) must clearly document, in the… Read more: Documentation of ordered test
- MDM and Problems AddressedQ: Under MDM noting that a problem is being managed by another provider does not count as the problem being managed during the visit. But what if I, the patient’s physician, note that I reviewed that provider’s recommendations with the patient to ensure they were compliant, understood the instructions and other possible treatment options? A:… Read more: MDM and Problems Addressed
- FQHC Funding ConsiderationsThe past year has presented many challenging situations for all businesses, and FQHCs have been hit especially hard with the COVID-19 pandemic. Throughout this time, they’ve seen shortages in PPE, staffing, and a demand for care like none other in their history. Fortunately, much funding has been made available to FQHCs to assist with their… Read more: FQHC Funding Considerations
- Prolonged time codes 99417 and G2212Q: I’m confused with time-based coding and counting prolonged time and differences between 99417and G2212. Please help! A: Both codes are designed to be reported only when using time-based coding according to the E/M guidelines and only with codes 99205 and 99215. The conundrum is related to application differences between the AMA and CMS. The… Read more: Prolonged time codes 99417 and G2212
