Vital Signs Blog

Federally Qualified Health Center Wrap Claims

Top Image

SUMMARY

Medic Management Group provides billing and collection services to private practices and hospital-employed groups throughout the United States.

Unique to the health care industry, Medic Management Group offers ASP-based practice management software. Our experienced team of professionals also can use existing software of the practice or hospital and can place medical billers on site at client hospitals.

Medic Management Group leads the collection of the amount due to the practice or health system. Our no-excuses style yields outstanding results.

Medic Management Group's medical billing program collects more than $150 million annually on behalf of our clients and manages an additional $120 million in medical collections in our management engagements.


CLIENT BACKGROUND

A Midwestern practice that employs five physicians, three dentists, and seven mid-level providers and is a Federally Qualified Health Center (FQHC) engaged Medic Management Group to assist in correcting billing issues.

Medic Management Group immediately identified the issue that most affected this practice: the inability to correctly bill its Medicaid "wrap" claims.

The primary payor for this type of practice is Medicaid, and therefore collecting the Medicaid "wrap" money is a vital revenue source. It is crucial the HMO Medicaid products are processed and submitted weekly to ensure a weekly Medicaid "wrap" check is received for both professional and dental claims.


CHALLENGE

The client suspected an issue due to a continued decrease in revenue, so it engaged Medic Management Group as its outsourced billing company.

At the time of engagement, the client was implementing a new electronic medical record (EMR), as well as a new practice management system. Medic Management Group helped set up the new billing software system while the client set up the new EMR system.

Through our extensive research, we identified the major cause for the decrease in revenue was the previous clearinghouse's inability to submit the Medicaid "wrap" claims correctly. As Medic Management Group began to work with the new practice management system, we identified the new clearinghouse also was unable to correctly transmit the Medicaid "wrap" claims.

Medic Management Group researched the market and identified a local clearinghouse that had previous experience in this unique billing requirement for FQHCs. Our professionals began to work with this new vendor to ensure the client received the maximum amount of revenue for their center. Within a few weeks, the client successfully began receiving weekly Medicaid "wrap" checks.

 

APPROACH / SOLUTION

Medic Management Group identified the client's clearinghouse did not have the expertise or ability to successfully submit Medicaid "wrap" claims. With the help of our professionals, the client engaged a local clearinghouse with the knowledge and expertise of this unique billing process. Within weeks, the client began receiving weekly Medicaid "wrap" checks.

 


RESULTS

As a result of Medic Management Group's findings, the client's monthly revenue has been increased by 25 percent for both its professional and dental encounters.

“The support from MMG helped us create a group that functioned as a cohesive business unit with many separate locations.”

— Kenyokee Crowell, Administrator, Regional Practices
Cleveland Clinic Health System