An FQHC success story.

What a challenge for a very small Texas FQHC. The FQHC had not come close to breaking even in 14 years of service. The small community depended on this facility and things were not looking good.

It was obvious they were plagued by staff turnover and the impossible task of finding qualified billers and insurance follow-up FTE’s. The billing office productivity and efficiency were at unacceptable levels and many mistakes were occurring. On top of that the patient billing was so inconsistent the community had become quite comfortable with just not paying their bill. The task was made more difficult by poor reporting and managements inability to understand the data before them.

There simply was no answer. They searched for a billing company to try to at least predict costs, but they were so small no billing company wanted to take them on. A losing proposition.

While researching FQHC capable billing companies, research showed that 8 of the 10 billing companies looked at outsourced at least a portion of their billing procedures to India. This was stunning. I have never been an advocate of offshoring.

This made me think. The billing companies were using the India companies for a reason. My first thought were costs. I enquired to a couple of India based companies seeking the answer. Much to my dismay, the companies using these India entities were not passing that savings on to their clients. It occurred to me to just cut them out of the equation. Why use a middle man when I can go straight to the source?

After review of several companies the decision was made to go with Planet Billing out of New Delhi. They made everything so easy. The contract was simple. No long-term obligation and they were trained and ready to roll on the NextGen system. Pretty much turn key. The best thing was a rate was negotiatd at less than 4%. Calculations showed that this alone could bring this small FQHC up to a break-even level, but what happened was much more effective than ever imagined.

This was the results:

1.     99% accuracy-Because of the lack of time and shortage of resources, the FQHC was facing problems in accuracy. However, the India solution produced 99.9% accuracy in claims billing, medical coding and claims adjudication.

2.     A marked increase in the level of productivity and efficiency

With the outsourcing of the revenue cycle management our employees and administration could focus all their time and effort on patient care. With healthcare staff totally focused on patients, we quickly saw a marked increase in our overall level of productivity and efficiency.

3.     Maximum profit margin at a minimal cost

Outsourcing coding, billing and insurance follow-up to India proved to be extremely beneficial for the FQHC, as we saved a whopping 60% on current cost

4.     Work completed ahead of schedule

When we outsourced to India, all our medical billing, medical coding, claims adjudication and medical transcription work was being completed within 24 hours, as our night is India’s day. With India’s unique 12-hour time zone advantage, we were always sure of important work getting completed ahead of schedule.

5.     Huge savings on capital expenditure

Cost is not the only thing we saved on by outsourcing healthcare services to India. We saved on time, manpower and healthcare infrastructure. We did not have to reinvest on expensive healthcare software and technology. We could concentrate on patient care and leave out worries regarding the management of healthcare staff and compliance with HIPAA.

6.     Access reports from anywhere at anytime

With a dedicated healthcare service provider handling all our work, we can quickly access any of our healthcare reports from our PC, phone or tablet to know the current status. With up-to-date reports, we could make informed decisions.

I am happy to report that this small FQHC is projected to break even this year. This is a great start and sets us up for a profitable future.

I know India is not for everyone and there is always the argument that by doing this we are taking jobs away from hard working Americans, but the truth is these are the hardest jobs to fill and bring to an efficient level in the industry. The benefit was if we could stay in business and at least get paid for the services we provided we could offer more services to our community. The trade-off was a no-brainer.

As a billing office consultant, I am happy that I have an answer for the smaller FQHC’s to help turn around broken infrastructures and help to build the sustainable FQHC of tomorrow!