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How FQHCs Can Discover Untapped Revenue

FQHCs Untapped Revenue


Community Health Centers are committed to serving the uninsured, underserved, and underserviced patients across our nation, often with little to no expectation that those bills will be paid.  Many State Medicaid programs provide retroactive coverage for patients; however, that information is not communicated back to health centers.

There could be hundreds, perhaps even thousands of unpaid encounters sitting in A/R that could be covered by retroactive Medicaid and have not reached the timely filing threshold.  Without some form of action, these encounters will expire due to timely filing and as a result, represent a loss of revenue.

There are things that a health center can do to take advantage of these programs and avoid unnecessary write-offs, but they are often burdensome and time consuming.

  1. Capture uninsured patients visits and track them post-encounter until they reach timely filing.
    This could be accomplished using your billing software if it provides for task management. Creating the ability to constantly track these encounters is the first key to discovering untapped revenue.
  2. Frequently verify patient eligibility.
    Determining patient eligibility can be accomplished numerous ways, through a phone call to a payer, or often through their Medicaid Portal. To verify eligibility, a patient must be located within the Medicaid system.  This will require specific patient demographic information such as name and date of birth, along with various other things.
  3. Update your billing system.
    Once a patient has been identified as having retroactive Medicaid, their member id and insurance information must be added into the billing system and all outstanding encounters updated so that claims can be generated and filed.

If the steps above seem like a lot of work, it is because it is.  In fact, depending on the size of the health center and amount of sliding fee and self-patients served, it could represent enough work for multiple full-time team members.

What if there was an easier way that could accomplish better results regardless of the billing system?


The good news is there is an easy to setup, risk free solution to this problem.  Visualutions now offers a service that checks for retroactive eligibility the entire timely filing lifespan of every self-pay and sliding fee visit. That is 365 days per visit of monitoring for Medicaid.   

This service could unlock payments for hundreds or thousands of encounters that are currently inflating A/R.  Because it is automated, health centers do not need to have full time staff focused on checking eligibility and tracking encounters.  Thousands of eligibility checks occur without having to click a single button.

The goal of this service is to ensure that a Health Center never miss another opportunity for reimbursement during the timely filing life of any visit, regardless of financial class - self-pay or sliding fee.

With every visit being scrubbed daily for 365 days, Health Centers can be certain that at the end of 365-days of tracking and verifying that all patients listed as self-pay and sliding fee are 100% not covered by Medicaid.


The implementation process is easy to understand and can be completed in one, one-hour remote meeting.

  • No required need to access to your system
  • No software to install
  • No upfront cost
  • No heavy lifting required by your organization
  • No risk
  • 100% contingency based
  • No long term contracts

The service is all report based.  If there is not an existing report that meets the data requirements for the service, one will be provided at no cost.

Once the report is generated and loaded within the tracking software, results will begin appearing within 24 to 48 hours. The information produced from the tracking service has all the details of each encounter along with the information needed for filing a claim.

Again, this service is -- Risk-free and 100% contingency based!


Still not sure that a service like this works?  The following information are a few examples pulled from actual customers currently using the service.

One customer in New Hampshire has found over 1,000 visits and recovered Over $85,000

A customer in the state of North Carolina has found over 22,000 visits, formerly documented as sliding fee in self-pay and has recovered over $580,000.

This next customer in the state of Maryland has found over 14,000 visits, formerly documented as sliding fee and self-pay and have recovered over 1.1 million dollars.

And finally, a customer in the state of Illinois which has a very complex methodology of documenting and finding Medicaid has found over 21,000 visits using this service and has recovered almost 1.8 million dollars.  Formerly that 1.8 million dollars was lost as unrecovered and Untapped Revenue.

Again, this service is: Risk-free, 100% contingency based, and with no long-term contracts!

To get started or for more information, contact