FQHC Revenue Cycle Management

Ensuring efficient and effective revenue cycle processes in a FQHC is crucial. The revenue cycle consists of all the administrative and clinical functions, processes, and software applications that contribute and manage the registration, charging, billing, payment, and collections tasks associated with a patient encounter. Revenue cycle is the process that begins when a patient comes into the system and includes all those activities that have occurred in order to have a zero balance. THINK…Zero to Zero!


 

As part of SCPHCA’s Training and Technical Assistance Program, we offer a variety of training and development opportunities across a wide array of associated topics. These trainings are led by national and state content experts and are designed to promote and maintain standards through the review and exchange of strategies, case studies, and best practice models across community health care settings. Information about up-coming training opportunities can be found on the on the Events tab at the top of the page. 

Association membership is not required to engage in training and technical assistance offerings supported by HRSA’s Cooperative Agreement Program.


 

Financial Management Networks

At the core of the SCPHCA’s training efforts are its discipline-specific networks. The opportunity for community health center peers and counterparts from across the state to network and share best practices is also a goal for the revenue cycle networks.  

Below is a list of the training networks facilitated by the SCPHCA.

  • Revenue Cycle - Billing & Collections Network
  • Revenue Cycle – Front Desk Services Network
  • Credentialing & Enrollment Network


Request Training or Technical Assistance


The SCPHCA also provides remote or on-site one-on-one technical assistance to community health centers in the state. To request remote or on-site training, please complete the training request form located under the member resources tab.


 

South Carolina Medicaid Program-General Information


Program Description

  • Established by Title XIX of the Social Security Act
  • Provides quality health care to low income, disabled, and elderly individuals by utilizing state and federal funds to reimburse providers for approved medical services.
  • South Carolina Department of Health and Human Services (SCDHHS) is the single state agency designated to administer the SC Medicaid program.
  • SCDHHS administers the traditional fee-for-service Medicaid program and offers two (2) Medicaid Managed Care Programs.

    **Click here to visit the SC Medicaid Program website


Medicaid Managed Care Organization (MCO) Program

 

  • Consists of contracted MCOs that provide approved medical services through a developed network of providers
  • SCDHHS pays a capitated rate per member per month, according to age, gender, and category of eligibility to MCOs.
  • Payments for core services provided to MCO members are the responsibility of MCOs, not the fee-for-service Medicaid program.
  • MCOs may elect to provide their members enhanced services beyond what is offered under traditional fee-for-service Medicaid.
  • SC Federal Qualified Health Centers participate in the traditional fee-for-service Medicaid program and the Medicaid Managed Care programs. Please contact the center in your area about the specific Medicaid Managed Care programs that are accepted.

 

Medicaid Bulletins

All Provider Bulletins
Bulletin Archives 
Dental Bulletins
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Bulletins
Pharmacy Bulletins 
Physicians Bulletins
Vision 
Waivers


 

Medicare Program-General Information

 

Medicare is a US federal health insurance program for:

  • people age 65 or older,
  • people under age 65 with certain disabilities, and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

 

Medicare has:

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Part C Medicare Advantage - A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

Part D Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Since 2006, Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
SC Federally Qualified Health Centers (FQHCs) are authorized Medicare providers. Not all SC FQHCs participate in the Medicare Advantage (Part C) program. Please contact the center in your area for specific Medicare Advantage Plan participation details. 

Medicare FQHC Page

Commercial Health Insurance-General Information

A type of health insurance that covers medical expenses and disability income for the insured. Commercial health insurance can be categorized according to its renewal provisions and type of medical benefits provided. Commercial polices can be sold individually or as part of a group plan offered by employers. These policies vary widely in the amount and types of specific coverage that they provide.

SC Federally Qualified Health Centers (FQHCs) contract individually with various commercial health plans. Please contact the center in your area for information about the commercial health plans that are accepted. 

SCPHCA
3 Technology Circle
Columbia SC 29203

P: 803. 788. 2778
F: 803. 778. 8233
E: information@scphca.org