Carolyn Yoder, Author at Practice Management

If you’ve been paying attention to federal health center policy this year, you know that the Community Health Center Fund is set to expire in December 2026. And if you’ve been leading a health center for any length of time, you may also know that this isn’t the first time a deadline like this has arrived.

The CHCF has faced funding cliffs before. In 2017, funding lapsed entirely when Congress missed the September 30 deadline, leaving health centers in limbo for nearly five months before a bipartisan budget deal restored and increased funding in February 2018. In 2019, a continuing resolution provided a two-month bridge while Congress worked toward a longer-term solution. Each time, advocacy held, extensions came through, and health centers continued to serve their communities.

That history matters. It doesn’t make the uncertainty comfortable, but it does provide context for how to think about December 2026: not as a likely end to federal health center support, but as a period of uncertainty that requires thoughtful preparation.

The 2017 lapse is instructive. Even before funding technically expired, the prospect of a cliff caused real operational disruption. Health centers froze hiring, some reduced staff hours, and other put planned renovations and program expansions on hold. The uncertainty itself, not just the lapse, was what created the most immediate harm.

That pattern can help health centers make educated (not emotional) decisions now. The financial risk of the December 2026 deadline may not ultimately come from a prolonged funding loss. It may come from decisions made in the months leading up to it (hiring pauses, deferred investments, or conservative budgeting that constrains operations) based on an outcome that may never materialize.

In our experience working in the FQHC world for nearly two decades, measured preparation is the right response. That means understanding what a temporary lapse would actually mean for your specific organization, building operational flexibility where you can, and strengthening the revenue streams you control, so that your financial foundation doesn’t rest entirely on what Congress does or doesn’t do before December 31.

Know Your Own Numbers

The first practical step is understanding exactly how much of your operating budget flows from CHCF funding specifically. For some health centers, mandatory and discretionary federal grant funding can represent roughly 26% of total revenue. For others, patient service revenue has grown to the point where the proportion is lower.

If you don’t have a clear picture of what a 60 or 90-day funding gap would mean for your cash flow, your payroll, and your program operations, now is the time to build that picture. A scenario-based budget that maps out what operations look like under three conditions (normal funding, a short-term delay, and a longer lapse) gives leadership a decision-making framework that keeps you from making crisis-style decisions.

Strengthen the Revenue You Control

Federal grant funding is funding that depends on decisions made in Washington. Patient service revenue is funding that depends on the care your team delivers every day, and that’s a meaningful distinction in an environment like this one.

Health centers that have built strong revenue cycle operations are better positioned to weather funding uncertainty because their financial foundation doesn’t shift when Congress misses a deadline. Every qualified encounter that gets properly documented and billed, every denial that gets worked and recovered, every wraparound payment that gets reconciled and submitted: that’s revenue your organization generates and controls.

This is also a good time to review where patient service revenue leaks are occurring in your current operation. Earlier this year we covered how FQHCs can strengthen revenue without adding services, including common workflow gaps like encounter documentation, same-day encounter optimization, and wraparound reconciliation that cost health centers revenue they’ve already earned. Tightening these workflows can be like tightening the fittings on a leaky pipe – which keeps more revenue in your financial pipeline!

If you’re also looking at the broader picture of how to reduce your organization’s dependence on grant funding over time, our free downloadable guide Beyond the Grant walks through both revenue cycle strategies and financial diversification approaches worth considering alongside your December planning.

Advocate, Plan, and Stay Informed

Health center advocacy has played a real role in every CHCF extension that’s come through. Staying engaged with NACHC and your state Primary Care Association throughout the fall keeps you informed of legislative developments and connected to the broader advocacy effort.

At the organizational level, the most valuable thing leadership can do right now is plan clearly, communicate honestly with staff and boards about the landscape, and avoid making reactive operational decisions based on an outcome that isn’t certain.

The health centers that navigated 2017 most effectively weren’t the ones that assumed the worst and panicked. They were the ones that understood their numbers, maintained operational flexibility, and kept their revenue cycle running at full strength throughout the uncertainty.

If your organization wants support building that kind of financial resilience, whether through strengthening your revenue cycle operations or working with our consulting team to identify where patient service revenue gaps exist, we would love to help.

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As we near the end of the year, many of the healthcare organizations we work with are beginning to look forward and plan for 2024. Part of this planning is updating, or even creating, a strategic plan. Strategic planning can be defined as “a process used by organizations to identify their goals, the str

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What the December 2026 Funding Cliff Means for Your Health Center’s Financial Planning

Posted on August 13, 2026August 13, 2026 by Carolyn Yoder

What the Uncertainty Actually Costs

Know Your Own Numbers

Alongside that, review your cash reserves. NACHC has noted that 42% of health centers hold 90 days or less of cash on hand. If your organization is in that range, strengthening reserves before December is worth prioritizing in your current fiscal planning.

Strengthen the Revenue You Control

Advocate, Plan, and Stay Informed

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Grant Funding Is Shrinking: What FQHCs Need to Do Now

Posted on July 30, 2026July 30, 2026 by Carolyn Yoder

For decades, Section 330 grant funding has been the anchor of FQHC financial planning. It’s the funding stream that offsets uncompensated care, supports workforce costs, and makes it possible to serve patients regardless of their ability to pay. And for most of that time, health center leaders could reasonably count on it being there.

That assumption is increasingly difficult to hold onto.

Between 2019 and 2023, federal grant dollars for FQHCs remained essentially flat while healthcare costs rose more than 25% over the same period, according to reporting in STAT News. By 2024, FQHC net margins had turned negative, sitting at approximately -2.1%. Health centers are now actively losing financial ground, and the grant funding that once provided a stable floor is no longer keeping pace with what it costs to operate.

But it’s not all doom and gloom. Community Health Centers are a vital and powerful piece of healthcare in the United States, and despite funding challenges they are serving up to 1 in 7 Americans. So, grant funding changes are not a reason to panic, they are a reason to act strategically so you can continue caring for the communities that need you.

Understand What You’re Actually Working With

According to KFF’s 2024 analysis, Section 330 grants made up just 11% of total health center revenue in 2024, with other grants and contracts adding another 15%. That share has declined significantly over time. In 2017, Section 330 funding represented closer to 18% of total revenue, and in 2010 it was as high as 38%. The trend is clear: patient service revenue has been carrying a growing share of the financial load for years, and that shift is accelerating. Grant funding matters enormously, but it was never meant to carry the full financial load, and it is increasingly less equipped to do so.

What’s changed is the pressure. When grant dollars shrink due to flat funding and rising costs, the gap has to be filled somehow. For many health centers, that has meant drawing on their reserves. According to NACHC, 42% of health centers currently hold 90 days or less of cash on hand, which leaves very little room for error when funding is delayed or a payer dispute creates a cash flow disruption.

The organizations that are navigating this environment most effectively aren’t waiting for grant funding to recover. They’re proactively building the revenue cycle infrastructure that allows patient service revenue to carry more of the weight.

Where Patient Service Revenue Leaks

Strengthening patient service revenue doesn’t always require new programs or expanded services. Often, it starts with recovering revenue that’s already being earned but is not being fully captured.

A few of the most common places you might be leaving money on the table:

Encounter documentation gaps. Under PPS billing, a visit that doesn’t meet encounter documentation requirements isn’t billable (not just underpaid, but entirely uncompensated). When providers document solely for clinical purposes without considering billing purposes, qualifying visits get missed.

Wraparound payment reconciliation. For FQHCs billing Medicaid managed care, wraparound payments bridge the gap between MCO rates and your full PPS rate. These payments don’t come automatically; they require systematic tracking and timely submission to the state. Health centers without a consistent reconciliation process often collect less than they’re entitled to.

Sliding fee verification backlogs. When income verification is incomplete, billing gets held. Encounters age unbilled while staff chases documentation, and some never get resolved. A streamlined verification workflow prevents revenue from stalling at the front end of the revenue cycle.

Denial management depth. A billing team at capacity often closes denial queues by writing off or resubmitting rather than investigating root causes. Denials that get worked down to their actual source help your team learn and grow, without making the same mistake over and over again. This means denials are far more likely to be resolved and far less likely to recur.

Building a Revenue Cycle That Carries More Weight

The health centers that are best positioned for the changing financial environment are the ones treating their revenue cycle as a strategic function rather than an administrative one. That means regular reporting on denial trends, payer mix shifts, and encounter volume. It also means establishing catch-up mechanisms for wraparound payments that might have been missed in prior quarters. And it means having staff capacity and expertise to work claims proactively rather than reactively.

For some health centers, that infrastructure exists in-house and just needs to be strengthened. For others, particularly those operating with lean administrative teams, the bandwidth simply isn’t there to run a high-performing revenue cycle while simultaneously managing everything else grant-funded operations require, and working with an expert outsourcing team that knows FQHC billing intricacies can be a game changer. Thinking about outsourcing? You can talk to our team here or check out this blog with tips on how to find the right outsourcing partner for your organization.

If your team is looking for a more complete picture of how to reduce dependency on grant funding while maintaining mission-driven care, our free downloadable guide Beyond the Grant: A Practical Guide to Diversifying Funding Streams for FQHCs walks through both revenue cycle strategies and broader financial diversification approaches worth considering.

Moving Forward

Grant funding isn’t going away, but it’s also not growing as an income source for community health centers. Thriving in this environment means closing your funding gap with a revenue cycle that captures every dollar of patient service revenue your hard-working team has already earned.

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The Documentation Gap: How Clinical and Billing Teams Lose Revenue Together

Posted on July 21, 2026July 21, 2026 by Carolyn Yoder

If you’ve been following our Documentation Gap series, you already know why clinical and billing teams struggle to communicate and what it takes to build better bridges between them. (If you’re joining us for the first time, Part 1 and Part 2 are worth a read before you continue.)

Now we’re going one level deeper. Communication is the foundation, but documentation is where revenue is won or lost. And for administrative and billing leaders, understanding exactly how documentation gaps form, and where leadership has the power to close them, is one of the highest-leverage things you can do for your organization’s financial health.

How Documentation Gaps Form in the First Place

Documentation gaps don’t suddenly appear because of one clunky process or a single communication mistake. They typically develop from a combination of workflow design, competing priorities, and assumptions that each side of the clinical-billing relationship makes about what the other already knows.

Providers assume their notes are sufficient because they capture what happened clinically. Billing teams assume that if a claim was submitted, the documentation must have been adequate. Neither assumption is always wrong, but together they create a blind spot where gaps go undetected by both teams until a payer flags them.

The most common documentation gaps administrative and billing leaders should be watching for include:

Missing specificity in diagnosis documentation. A provider may document a condition clearly enough for clinical purposes, but without the specificity required to support the billed code. “Diabetes” is a diagnosis. “Type 2 diabetes with diabetic chronic kidney disease, stage 3” is a billable one. That specificity gap is the difference between a clean claim and a denial.
Unsupported visit complexity. When the level of an evaluation and management (E/M) service doesn’t match the documentation, claims get denied or downcoded. The most frequent issue isn’t necessarily overcoding (although that can be its own separate issue), but instead it’s providers who deliver complex care and document it at a lower level because thorough documentation takes time they don’t always have.
Disconnected service documentation. When multiple services are delivered in a single visit, each one needs its own clear documentation trail. If a provider sees a patient for a primary care visit and also addresses a behavioral health concern, both need to be documented distinctly or only one gets reimbursed.
Missing or incomplete plan of care. Payers often require a documented plan of care to support ongoing treatment. When that documentation is incomplete or absent, recurring claims for the same patient become increasingly vulnerable to denial over time.

Where Leadership Comes In

Here’s what makes this a leadership issue rather than a frontline one: documentation patterns are systems problems, and systems problems require systems solutions.

Individual providers can’t audit their own documentation gaps effectively while also seeing a full patient panel. Billing staff can catch issues after the fact, but by then the claim is already delayed or denied. The leaders who sit between those two realities, CFOs, practice administrators, RCM directors, are the ones positioned to see the full picture and act on it.

A few places where administrative and billing leadership can make meaningful impact:

Review denial data by root cause, not just by volume. If your team is tracking denial rates but not categorizing them by reason, you’re missing the most important signal. Documentation-related denials look different from eligibility denials or timely filing issues. When you separate them out, patterns emerge that point directly to where documentation gaps are concentrated, giving you the insight you need to talk to your team and point them towards the training they need.
Create accountability at the leadership level, not just the provider level. When documentation expectations are communicated from clinical leadership to providers, they carry more weight than when they come from billing staff. Administrative leaders can advocate for that dynamic by bringing documentation performance data into regular conversations with clinical leadership instead of only addressing it during crisis moments.
Treat documentation feedback as ongoing, not episodic. One-time training sessions rarely change behavior sustainably. The organizations that see lasting improvement build feedback into their regular operational rhythm, reviewing documentation trends monthly, sharing patterns with clinical leadership, and tracking whether targeted changes are moving the numbers in the right direction.
Know what you don’t know. This is perhaps the most important one. Many documentation gaps are invisible until an outside review surfaces them. Organizations that haven’t had a formal documentation or coding audit in the past 12 to 18 months often discover that patterns they assumed were resolved have quietly continued, or that new gaps have formed as payer requirements changed.

The Cost of Waiting

Every month that a documentation gap goes unaddressed is a month of claims being denied, downcoded, or paid at a fraction of their appropriate value. For most healthcare organizations, that adds up faster than it appears in any single report.

But we have good news: documentation gaps are among the more correctable revenue cycle problems! They don’t require new technology or major operational restructuring. They require clear expectations, consistent feedback, and leadership willing to treat documentation performance as the financial priority it is. (If you’re not sure where your organization’s documentation gaps are hiding, our consulting services could be exactly what your team needs!)

Your teams are already working hard – when leadership creates the systems that connect that work to clean, complete documentation, everyone benefits! And your staff has more time to pour into the patients whose care depends on your financially healthy organization.

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Is Your Billing Team Keeping Up or Running on Empty?

Posted on July 7, 2026July 7, 2026 by Carolyn Yoder

There’s a version of a billing department that looks fine from the outside: Claims are going out, reports are being generated, and nobody is sending urgent emails about a crisis.

And then there’s what’s happening internally: a small team quietly working through a backlog that never quite clears, handling denials reactively, and staying afloat mainly because everyone is working harder than they should have to. The wheels are still turning, but the gears are grinding.

This is one of the more common and more costly situations in healthcare revenue cycle management. Your department is not in crisis, but it is at capacity. This means your hardworking team is stretched thin enough that small problems can become big ones before anyone has time to address them.

Here are some signs that your billing team may be surviving rather than thriving, and what to do about it.

The Warning Signs

AR is aging in the wrong direction. When a team is at capacity, older claims get deprioritized in favor of keeping up with new submissions. The result is a gradual creep in your 60- and 90-day AR buckets. If your AR over 90 days is consistently above 10% of total receivables, that’s worth investigating.

Denials are being closed, not resolved. A stretched team often closes denial queues by resubmitting or writing off rather than investigating root causes. If your denial rate is climbing or your write-off volume is increasing without a clear explanation, it may signal that denials are being managed for volume rather than outcomes.

Reporting is reactive, not proactive. When teams are overwhelmed, reporting becomes something that happens when someone asks rather than something that drives decisions. If your billing team’s reports primarily answer questions after the fact rather than flagging trends in advance, that’s a capacity signal worth paying attention to.

Turnover is higher than it should be. Billing staff who are consistently overloaded leave. If your team has seen meaningful turnover in the last 12 to 18 months, it’s worth asking whether workload played a role, because replacing experienced billing staff is expensive and slow. If you’re not asking already, make sure your exit interviews include an opportunity for exiting staff to address workload honestly.

Follow-up timelines are slipping. Payers have timely filing limits, and appeals have deadlines. When a team is stretched, follow-up timelines are often the first thing that slips, which means revenue that could have been recovered quietly disappears instead.

How to Support Your Hardworking Team Now

The instinct when a billing team is struggling is often to look for a single fix: a new software system, a process overhaul, or a policy change. Those things can help, but they typically don’t address the core issue if the core issue is capacity.

Start with an honest workload assessment. How many accounts is each team member managing? What is the ratio of claims to follow-up staff? Are there tasks being done manually that could be systematized or automated? Sometimes the answer is a workflow adjustment, and sometimes an assessment reveals that the team is simply understaffed for the volume they’re handling.

Look at your denial data by root cause. Before assuming your team needs more training or better processes, find out whether your denial patterns are driven by avoidable errors (coding issues, missing information) or by payer behavior (incorrect contract rates, technical rejections). These require very different responses.

Consider targeted outside support before a full overhaul. Hiring in healthcare is genuinely difficult right now. Experienced billing staff are in short supply, and onboarding takes time your revenue cycle may not have. One option worth considering is working with an external RCM organization that can step in for specific functions, such as AR cleanup on an aging backlog or consulting support to identify and fix process gaps, without requiring you to hand over your entire billing operation.

The best external partners in this space don’t operate on an all-or-nothing model. They work alongside your internal team, filling gaps where the need is greatest and adjusting their involvement as your team’s capacity stabilizes. That kind of flexibility matters, especially for organizations that want to preserve their internal billing function while getting the support they need right now.

The Bigger Picture

A billing team that is merely surviving isn’t just about staffing. Every claim that ages past the point of recovery, every denial that gets written off instead of appealed, and every follow-up that slips past a filing deadline represents real money that should have made it into your organization.

Addressing your team’s capacity before it reaches a breaking point is almost always less expensive and less disruptive than addressing it after. The signs are usually there early, and if your leadership team is looking for them, you can step in to support your dedicated billing team before they reach burnout.

If your team is showing some of these signals and you’re not sure where to start, Practice Management offers AR cleanup and consulting services designed to work alongside existing billing teams, not replace them. Reach out to see how our services can slot into your existing structure – we’d love to help!

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Why Your Payer Mix Deserves a Seat at the Strategy Table

Posted on June 24, 2026June 19, 2026 by Carolyn Yoder

Payer mix may be one of the most important numbers in your financial picture, and it’s often one of the least discussed in day-to-day operations.

Most healthcare leaders know their payer mix exists somewhere in a report, but they don’t always treat it as a strategic indicator that should actively shape budgeting, staffing, and program decisions. This is a missed opportunity in a funding environment where payer mix can shift faster than most centers are prepared for.

A Quick Refresher

Payer mix is the percentage breakdown of who pays for the care you provide: typically Medicaid, Medicare, private insurance, and self-pay or uninsured patients on a sliding fee scale.

Nationally, about half of health center patients are covered by Medicaid, 22% have private insurance, and 18% are uninsured, according to KFF’s analysis of HRSA Uniform Data System figures. Medicaid is also the largest revenue source for health centers, accounting for 45% of total health center revenue nationally in 2024.

Your center’s mix almost certainly looks different, and that’s exactly the point. How your specific mix moves over time gives you insight that national numbers can’t.

How to Pull and Read Your Own Numbers

Most practice management or EHR systems can generate a payer mix report by patient volume and revenue. Pull this quarterly, comparing against the same quarter the prior year and the previous quarter, since payer mix has seasonal patterns (open enrollment, school-based insurance changes, agricultural worker coverage shifts in some regions) that a single-quarter comparison can miss.

Look at volume by payer and revenue by payer side by side. These numbers are rarely identical, and the difference matters. A payer category might represent a small share of your volume but a large share of your revenue, or the reverse, which tells you where your financial risk sits.

What Shifts in Payer Mix Actually Signal

A change in payer mix is usually a signal about something shifting in your community or funding environment.

The clearest recent example is Medicaid redetermination. When continuous Medicaid enrollment protections ended in 2023, health centers nationally felt the impact quickly. An estimated 23% of health center Medicaid patients were unenrolled during the process, according to a joint NACHC and George Washington University survey. Health centers reported average Medicaid revenue losses of nearly $600,000 per center as a direct result.

That kind of shift doesn’t show up as a single bad month on your reports. It shows up gradually, as patients who previously had Medicaid coverage become uninsured or move into marketplace plans with different reimbursement structures. If you’re only reviewing payer mix annually, a shift like this can be well underway before it’s visible in your financial reports.

Other signals worth watching include a rising self-pay or uninsured percentage (often meaning more care delivered at reduced or uncompensated rates), a growing share of high-deductible commercial plans (which can mean slower collections despite the payer being “commercial”), and concentration risk, where a large share of revenue depends on a small number of MCO or commercial contracts.

Why This Should Inform Your Strategy

Payer mix data is most useful when it moves beyond the finance team’s stand-up meetings and into planning conversations with leadership.

If your Medicaid percentage is declining and your uninsured percentage is rising, that has direct implications for sliding fee scale staffing, grant funding strategy, and 340B program planning, since a meaningful share of health centers expect 340B revenues to decline as Medicaid coverage shifts. If a particular MCO represents a disproportionate share of your revenue, that’s worth factoring into your wraparound reconciliation process and contract renewal conversations.

Payer mix should also inform conversations about new programs or service lines. A behavioral health expansion looks financially different depending on whether your existing behavioral health patients are predominantly Medicaid, commercial, or self-pay. Reviewing payer mix alongside any major program decision helps you anticipate revenue cycle implications before you launch,instead of discovering them afterward.

Not an FQHC? What You Should Know

While payer mix is especially significant for FQHCs given their reliance on Medicaid and grant funding, the underlying concept applies to any healthcare organization. Group practices and specialty clinics benefit from the same quarterly review habit: tracking volume and revenue by payer, watching for shifts in commercial versus government payer concentration, and factoring those trends into staffing and service line decisions.

Moving Forward

Payer mix is not just a number for your annual report. These ratios act as an early indicator of where your financial pressure points are likely to emerge, and they deserve a regular place in your strategic conversations.

If your team needs support building out payer mix reporting or interpreting what your data is signaling, our team would love to talk!

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Five Questions to Ask Before You Outsource Your Billing

Posted on June 11, 2026June 8, 2026 by Carolyn Yoder

Outsourcing your billing is one of the more significant operational decisions your healthcare organization can make. When you pick the right company, outsourcing frees up internal resources, tightens revenue cycle performance, and gives your team more bandwidth to focus on patient care. If you get saddled with the wrong partner, it creates more problems than it solves.

The difference often comes down to how thoroughly you evaluated both your own readiness and the strengths (and weaknesses) of vendors you considered before signing a contract.

We’ve been handling revenue cycle management for healthcare organizations across the country for over 30 years – these are the top five questions you should be asking every potential outsourcing vendor before you sign on the dotted line.

1. Are we actually ready to outsource?

This question gets skipped more often than it should. Outsourcing your billing is not an automatic fix for a disorganized revenue cycle. If your charge capture process has gaps, your documentation is inconsistent, or your payer contracts haven’t been reviewed in years, an external billing team will inherit those problems and if the external team isn’t armed with the experience and bandwidth to build out those new workflows for you (and then provide training and education for your team) it means one of two things: either you’re not ready for outsourcing yet, or they are not the right vendor for you.

Before evaluating vendors, do an honest internal assessment. How clean is your data? Are your denial rates within normal benchmarks, or are there patterns suggesting deeper workflow issues?

If you’re not sure where to start, our free resource Are You Ready for Revenue Cycle Management? walks through the key areas to assess before making the transition.

2. Do they have meaningful experience in your specific setting?

Healthcare billing is not one-size-fits-all. A billing organization with strong experience in orthopedic group practices may have very little familiarity with community mental health billing. A team that handles hospital outpatient well may not understand the nuances of independent physician practice reimbursement.

Ask potential billing organizations to be specific about their experience in your care setting, your specialty mix, and your primary payer types. Ask how many current clients they serve in a similar setting. Vague answers to specific questions are worth paying attention to.

3. Who will you actually be working with, and how often will you hear from them?

This question reveals more about a billing organization than almost any other. Once a contract is signed, the friendly (and incredibly available) Sales Team disappears, and you’re left with the day-to-day relationships with your new billers. What those look and feel like matter enormously.

Find out whether you’ll have a dedicated point of contact or whether your questions go to a general support queue. Ask what a typical communication cadence looks like. Will you have regular meetings to review performance and flag concerns? Or will you receive a monthly report and otherwise be left to reach out when something goes wrong?

The most effective outsourcing relationships tend to feel less like a vendor arrangement and more like an extension of your internal team. A billing organization that proactively communicates and genuinely engages with your mission brings much more value than one that simply processes claims.

4. How do they handle denials and appeals?

Denial management is where a lot of billing organizations quietly underperform. Submitting clean claims is the baseline. What separates strong performers from average ones is what happens after a claim is denied.

Ask vendors to walk you through their denial management workflow. How quickly are denials worked? Do they track denial trends by payer and reason code to identify root causes, or do they just resubmit individual claims? Ask for benchmarks from their current client base and how their performance compares to industry standards.

5. What does the contract actually say?

It’s easy to focus on the pitch and give less attention to the contract itself, but reading the fine print is well worth your time.

Before signing, understand the termination clause. How much notice is required, and what does the data return process look like if you decide to leave? Look for performance guarantees, and if they are included in the contract, make sure you understand how disputes are handled if their performance falls short.

Contracts that are easy to exit (with reasonable notice and a clean data handoff) typically signal a vendor confident in their ability to retain clients through performance rather than obligation.

Bonus: Additional Questions for FQHCs

If you are a Federally Qualified Health Center, there are a few additional questions specific to your billing environment worth asking directly.

Do they have verified experience billing under the Prospective Payment System?

PPS billing is meaningfully different from fee-for-service. Encounter qualification rules, same-day visit protocols, and UDS reporting requirements all require specific familiarity. Ask how many FQHC clients they currently serve and whether they have staff dedicated to health center billing specifically.

How do they handle Medicaid managed care wraparound reconciliation?

Wraparound payments are a significant revenue stream for most FQHCs and require systematic tracking and timely submission. Ask what their reconciliation process looks like, how frequently they submit, and whether they’ve identified missed wraparound payments for clients they’ve onboarded.

Are they familiar with HRSA compliance requirements as they relate to billing?

Billing and HRSA compliance intersect more than many health centers realize, particularly around credentialing, privileging, and encounter documentation. A billing organization that understands your federal designation requirements can flag compliance-adjacent issues before they become problems, not after.

Outsourcing your billing is a significant decision, and the right fit looks different for every organization. Taking time to ask the right questions before you commit is the most reliable way to make sure the relationship you enter actually serves your team, your patients, and your mission.

If you’d like to talk through where your organization stands, we’d love to connect!

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Credentialing Delays and the Revenue They Cost You

Posted on May 28, 2026May 28, 2026 by Carolyn Yoder

When a new provider joins your organization, the focus is naturally on getting them up and running. But quietly running in the background is a process that directly controls when that provider can start generating revenue: credentialing and payer enrollment.

For many healthcare organizations, credentialing doesn’t get the operational attention it deserves until something goes wrong. A provider who’s been seeing patients for two months suddenly can’t bill because enrollment paperwork fell through the cracks. Claims come back denied. Revenue that should have been collected sits unrecoverable because timely filing limits have passed.

Credentialing bottlenecks are one of the most consistently overlooked sources of revenue loss in healthcare, and they affect practices, health systems, and community health centers alike.

What the Delay Actually Costs

The financial impact is straightforward: until a provider is credentialed and enrolled with a payer, they cannot bill that payer for services rendered. Every day of delay is a day of unbillable care.

The average credentialing process takes 90 to 120 days, though timelines can stretch to six months depending on payer type, provider specialty, and state requirements. Physicians and surgeons stand to lose up to $122,144 during a 120-day delay. Nurse practitioners and physician assistants can lose up to $66,000 over the same period.

The problem compounds when you’re onboarding multiple providers at once. Each provider in a credentialing queue represents its own revenue gap, and those gaps add up in ways that don’t always surface in standard reporting until it’s too late to recover.

Where Delays Typically Come From

Credentialing delays are rarely the result of a single failure. They’re usually several small gaps compounding on each other.

Incomplete or inconsistent documentation is one of the most common causes. Applications submitted with missing information trigger requests for additional documentation, adding weeks before a payer even begins their review.
Slow primary source verification is another frequent bottleneck. Payers verify credentials directly with medical schools, licensing boards, and training programs, and those institutions don’t always respond quickly. Without active follow-up, applications can sit for weeks with no movement.
Multi-payer complexity adds further friction. Each payer has its own application process, documentation requirements, and approval timelines. A provider might receive Medicare enrollment in 60 to 90 days while waiting four additional months for a commercial carrier.
Reappointment lapses are an often-overlooked ongoing risk. Credentialing isn’t a one-time process. When renewals slip through the cracks, organizations can find billing suddenly interrupted by a provider whose credentials have lapsed.

Credentialing as a Revenue Protection Strategy

The most important shift organizations can make is treating credentialing as a core revenue protection strategy rather than an administrative function.

In practice, that means starting enrollment before a provider’s first day, assigning clear ownership with defined follow-up timelines, and maintaining visibility into upcoming reappointment dates so renewals aren’t initiated at the last minute. Tracking time-to-first-claim (the period between a provider’s start date and first successful claim submission) as a performance metric gives finance and operations leaders a concrete way to measure how well the process is working.

What about FQHCs?

For community health centers, credentialing carries complexity that goes beyond what other healthcare organizations face.

FQHCs are required to credential and privilege a wider scope of providers than most healthcare organizations, including registered nurses, licensed practical nurses, certified medical assistants, and community health workers in addition to clinical providers. This requirement comes from HRSA and is tied directly to maintaining your federal designation and FTCA coverage.

Credentialing delays also affect PPS encounter volume in a way that doesn’t apply to fee-for-service organizations. An uncredentialed provider delivering care that can’t be billed as a qualifying encounter is a direct hit to the revenue stream that keeps your programs running and your community served.

Limited staff bandwidth makes this especially challenging. When one person manages credentialing alongside several other administrative responsibilities, follow-up gaps are almost inevitable, which is why dedicated external support often makes a meaningful difference for health centers navigating this workload.

Moving Forward

Credentialing delays are one of the more solvable revenue cycle challenges. The core fix is operational: clear ownership, proactive timelines, and consistent follow-up across every payer and every provider.

Your team is already delivering the care. Making sure providers are enrolled and billing as quickly as possible after they start is simply a matter of treating credentialing as the revenue-critical function that it is.

Practice Management offers credentialing and enrollment support for healthcare organizations nationwide, including group practices and FQHCs navigating the additional complexity of HRSA requirements and PPS billing. If your organization is experiencing delays or wants to strengthen your enrollment processes, we’d love to help!

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How FQHCs Can Strengthen Revenue Without Adding Services

Posted on May 14, 2026May 14, 2026 by Carolyn Yoder

Healthcare organizations are focused on year-over-year growth, and this usually means adding new programs and services. But it doesn’t always have to. Sometimes the strongest financial improvements come from tightening up what you’re already doing.

For Federally Qualified Health Centers operating on tight margins, launching new programs or adding service lines isn’t always realistic. Your staff is already stretched thin, grant funding cycles don’t always align with when you need capital for growth, and adding a new program on top of an already stacked deck of services can sometimes create unnecessary complexity without creating significant community impact.

But new services are not the only way to grow! Many FQHCs are leaving revenue on the table in their existing workflows. Not because you’re doing anything wrong, but because the billing model you work within (Prospective Payment System, sliding fee discounts, wraparound payments, multiple payer types) creates natural gaps where revenue quietly slips through.

Let’s look at where those gaps typically show up and what high-performing health centers do differently.

The Encounter Documentation Gap

Under PPS billing, you receive a fixed rate per qualifying encounter regardless of how many services you provide during that visit. This makes every encounter valuable, but it also means that if a visit doesn’t meet the specific criteria for a billable encounter, you lose the entire payment (not just a portion of it).

What makes an encounter billable? It needs to include a medically necessary service, be provided by a qualified provider (physician, nurse practitioner, physician assistant, licensed clinical social worker, clinical psychologist, or certified nurse midwife), involve face-to-face interaction (in most cases), be comprehensive enough to count as the primary visit for the day, and be properly documented.

The challenge shows up when documentation is incomplete. A provider sees the patient, delivers excellent care, but the note doesn’t clearly establish medical necessity or doesn’t document the face-to-face component. When the billing team reviews the encounter, they can’t submit it because required elements are missing.

What works better: Brief monthly training sessions where clinical staff review what qualifies as a PPS-eligible encounter. When providers understand that specific documentation elements trigger payment (not just good clinical notes), accuracy improves without adding administrative burden. Consider creating a simple checklist that outlines the must-have components and share examples of complete versus incomplete encounter documentation.

Same-Day Encounter Optimization

PPS rules generally do not allow for multiple billable encounters on the same day, but there are a few exceptions. For example, if a patient has a medical visit and a behavioral health visit on the same day it can generate two separate PPS payments, as long as each encounter is properly documented with distinct providers and separate notes.

Many health centers miss this opportunity because front desk staff aren’t trained on same-day scheduling optimization or because clinical teams don’t realize that combining visits in one note collapses two billable encounters into one payment.

What works better: Train scheduling staff to spot these exceptions and to schedule those appointments appropriately. Make sure clinical teams understand that separate encounters require separate documentation, even when they occur on the same day. A simple workflow adjustment (ensuring each qualifying visit has its own distinct note with the appropriate provider signature) can significantly increase your encounter count without adding patient volume.

Wraparound Payment Reconciliation

For FQHCs billing Medicaid managed care, wraparound payments bridge the gap between what the MCO pays and your full PPS rate. If your PPS rate is $180 and an MCO pays you $120 for an encounter, the state owes you a $60 wraparound payment to make up the difference.

The problem is that wraparound reconciliation often happens quarterly, involves manual tracking of which encounters were paid by which MCO at what rate, and requires submitting documentation to the state for supplemental payment. If your team doesn’t have a systematic way to track this, wraparound payments get missed entirely or submitted late (creating cash flow gaps even when you eventually receive the payment).

What works better: Establish a regular reconciliation schedule (monthly is ideal, quarterly at minimum) where you’re comparing MCO payments to your PPS rate and identifying the gap. Document which encounters are owed wraparound payments and submit that documentation to the state within the filing window. Some health centers assign one staff member to own this process rather than spreading it across multiple people, which reduces the chance of payments falling through the cracks.

Sliding Fee Scale Verification Delays

FQHCs are required to offer sliding fee discounts based on verified patient income and household size. This is a core part of FQHC operations, but it can also create a billing workflow challenge.

When income verification is incomplete or delayed, billing gets held up. You can’t finalize the patient’s discount level, which means you can’t determine their responsibility, which means the encounter sits unbilled while you wait for documentation. If verification takes weeks (or if it never gets completed), you’re carrying unbilled encounters that age while staff chases paperwork.

What works better: Set a clear timeline for when income verification must be completed and establish who is responsible for follow-up when documentation is missing. Making sure that one or more staff members know that they are the owners of these processes will help them get addressed in a timely manner. Some health centers implement a “temporary discount” policy where patients are assigned a standard discount level at registration, allowing billing to proceed, with adjustments made once full verification is received. Others dedicate specific staff time each week to completing outstanding verifications rather than waiting for patients to bring documents back on their own. Finding a system that works for you will help you collect the correct revenue from patient payments.

Small Workflow Adjustments Create Real Impact

Targeted improvements to specific parts of your existing operation that are causing revenue leakage can create big impact and ultimately, growth!

The reason they work is because they address root causes rather than symptoms. Training clinical staff on encounter documentation requirements prevents unbillable visits before they happen (rather than catching them after the fact when it’s too late to fix). Optimizing same-day scheduling captures revenue you’re already generating but not billing for. Implementing a specific process for wraparound reconciliation ensures you collect payments you’re entitled to but might be missing.

Even small percentage improvements in encounter capture or payment reconciliation translate to meaningful revenue when applied across your entire patient population. And because these adjustments strengthen existing workflows rather than adding new complexity, they’re sustainable without increasing staff workload or operational costs.

Moving Forward

Strengthening revenue doesn’t have to mean doing more. Sometimes it means doing what you’re already doing more consistently, more accurately, and more completely.

If your team is stretched thin managing the complexity of PPS billing, wraparound reconciliation, and encounter documentation requirements, you’re not alone. Many health centers find that working with revenue cycle partners who specialize in FQHC billing provides the expertise and systematic processes needed to capture revenue that might otherwise slip through the gaps.

Whether you choose to optimize workflows internally or bring in external support, the opportunity is there. Your team is already delivering the care. Making sure you’re capturing the revenue for that care is simply a matter of tightening the workflows that connect clinical delivery to billing submission.

Practice Management has worked with FQHCs since 2011, supporting health centers with full revenue cycle management services and targeted consulting to identify and address revenue leakage. If you’re looking to grow without adding service lines, we’re here to help.

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Your Revenue Is Aging While You Wait

Posted on April 28, 2026April 28, 2026 by Carolyn Yoder

You open your accounts receivable aging report and see $250,000 in the 90+ day bucket. These claims were billed months ago. They’re technically still collectible. So why does that number matter so much?

Because by the time a claim reaches 90 days, you’ve often missed your best opportunities to resolve it efficiently. The payers who were responsive at 30 days may not remember the claim at 90. The documentation that was easy to locate in week two is buried by month three. And those timely filing deadlines? Some of them have already passed.

The most expensive billing problems are often the ones that age quietly in the background while your team focuses on newer work. Let’s talk about why earlier intervention matters and what that can look like in practice.

Why Claims Age Faster Than You Think

Claims don’t age because billing teams forget about them. They age because small issues go unnoticed until they become bigger problems.

Here’s the pattern we see playing out over and over again: A claim gets submitted with a minor coding error and is denied at 15 days. Your team doesn’t catch the denial notification for another week. By the time someone investigates, corrects the code, and resubmits, the claim is at 35 days. If that resubmission has another issue (maybe a missing modifier this time), you’re suddenly at 60 days before anyone realizes the claim still hasn’t paid.

Reworking a denied claim costs providers an average of $25 and can get as high as $118, and that doesn’t even factor in the revenue delay. When this pattern repeats across dozens of claims, aging AR stops being just a collections issue and starts being a workflow issue.

The other common driver for aging AR? Lack of structured follow-up. Without a system that triggers action at specific intervals, claims can slip from 30 to 60 to 90 days without a single touchpoint. No one calls the payer. No portal check happens. The claim just sits there, aging.

What Changes at Each Stage

The aging buckets on your AR report aren’t arbitrary. They represent meaningful shifts in how hard claims are to collect and how much effort is required to resolve them.

In the 0 to 30 day range, most claims are still in normal processing timeframes. Many payers process claims within 30 days, so accounts in this bucket are either pending or recently paid. Best-in-class billing operations maintain around 65% or more of total AR here.

Once claims hit 31 to 60 days, intervention becomes more valuable. A claim sitting at 45 days isn’t necessarily denied. It might be pending additional review, stuck in a payer queue, or waiting on documentation your team didn’t realize was requested. A quick portal check or phone call at this stage often reveals the issue and gives you time to resolve it.

By 61 to 90 days, you’re working against timely filing deadlines. Many commercial payers enforce 90-day filing windows, and some are shorter. At this point, anything in this bucket deserves high-priority attention.

Industry research shows that collectability drops significantly as claims age, which is why the HFMA recommends keeping AR over 90 days below 10% of total receivables. After 90 days, collectability drops significantly. These claims are expensive to work, difficult to resolve, and increasingly at risk of timing out completely.

What Works: Building Earlier Touchpoints

The solution to growing AR is not working harder on old claims but instead focusing on catching issues earlier, when they’re still manageable.

High-performing revenue cycle teams implement structured follow-up at 30 and 60 days, when claims are still fresh and payers are responsive. One effective approach is a regular review cadence: checking claims at 7 days to confirm payer receipt, 17 days to check processing status, and 30 days to escalate if payment hasn’t been received. This rhythm keeps claims in active status rather than passive waiting.

Segmenting your AR by aging bucket also helps your team prioritize. Claims in the 61 to 90 day range typically need more attention than those in the 0 to 30 day range, and anything approaching a filing deadline should be flagged immediately.

Clean claim submission matters just as much as follow-up. The more claims you can get paid on first submission, the fewer end up aging. Real-time eligibility verification, pre-submission claim scrubbing, and accurate coding all reduce denials, which directly reduces the volume of claims that need rework.

Weekly AR aging reviews can make a big difference too. When leadership reviews aging reports weekly instead of monthly, problems surface faster and teams can course-correct before small issues become patterns.

Why This Matters More for FQHCs

Federally Qualified Health Centers often face additional pressure around AR aging. Many FQHCs operate on thin margins (on average around 2.9%), which means even modest delays in collections can create operational strain.

The payer mix at most FQHCs includes high percentages of Medicaid, Medicare, and uninsured patients. Each requires different follow-up approaches and different timely filing rules. Medicaid managed care plans, in particular, often have shorter filing windows than traditional Medicaid, and missing those deadlines means losing revenue your health center has already earned.

Grant funding cycles also make cash flow management more complex. Section 330 grants provide critical support, but they don’t replace the need for strong patient service revenue. When AR ages and cash flow tightens, health centers may find themselves unable to cover operational expenses between grant disbursements, even when their overall financial position looks stable on paper.

For FQHC leadership, monitoring AR aging isn’t just about collections performance. It’s about organizational sustainability. Best practice for health center liquidity is a minimum of 90 days cash on hand, and high AR aging directly impacts your ability to maintain that cushion.

Moving Forward

Reducing aging AR doesn’t require a complete overhaul – just consistent habits applied at the right intervals.

Start by reviewing your current AR aging distribution. If more than 20% of your total AR is sitting in buckets older than 60 days, earlier intervention could help. Look at what’s causing claims to age. Are denials going unnoticed? Is follow-up happening too late? Are coding errors creating rework cycles that add weeks to resolution time?

Then build a follow-up rhythm that fits your team’s capacity. If you can’t implement a detailed cadence immediately, that’s okay! Start simple and add more touchpoints as your team adjusts. Consistency matters more than complexity.

The 90-day mark isn’t when AR work begins. It’s where AR work becomes exponentially harder. By shifting your focus to earlier intervention, you can protect revenue before it becomes at risk, reduce the cost of collections, and build a revenue cycle that works proactively.

If your organization needs support building more effective follow-up workflows or strengthening your revenue cycle processes, our team at Practice Management would love to talk.

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Monthly EHR Reports That Protect Revenue

Posted on April 16, 2026 by Carolyn Yoder

Your EHR system contains the data you need to catch revenue leaks before they become financial problems. But most healthcare organizations only pull reports sporadically, review them reactively, and miss the patterns that signal where revenue is slipping through the cracks.

Monthly reporting rhythms create accountability, reveal trends, and give leadership the visibility needed to make informed decisions. Let’s dive into some of the monthly reports great RCM teams should be running regularly, and why that data matters!

Why Monthly Matters

According to MGMA data, charge capture failures cost the average multi-provider practice between 1% and 5% of potential revenue. For a practice generating $3 million annually, that’s $30,000 to $150,000 in services rendered but never billed.

These failures accumulate gradually, and without regular reporting, small gaps compound into significant revenue loss before anyone notices. Monthly reviews help you create a baseline for your organization – after all, you can’t spot trends if you’re only looking at data occasionally.

Quick disclaimer: We won’t be listing all the specific reports for all the popular EHRs – software is constantly updating, and different specialties prefer different systems. Instead, we will describe the reports, the data they contain, and offer some of the most commonly used report names. Once you know what kind of data you’re looking for, finding (or building) that report in your own system becomes possible! Looking for custom reporting? Check out our billing department assessment services.

The Core Reports Every Organization Needs

Charge Reconciliation Report

This report compares your schedule or appointment log to charges posted. Ideally, charges should be reconciled daily, or at least weekly, but a monthly review of your reconciliation patterns is an absolute must. Look for departments or providers who consistently show gaps between appointments and posted charges.

Most EHR systems can generate this by comparing scheduling data to billing data. Look for report names like “charge capture review,” “encounter reconciliation,” or “schedule vs. charges.”

Aging Accounts Receivable Report

This shows how long claims have been waiting for payment, broken down by time periods. Anything between a 30 and 45 day average in AR means claims are moving. More than 90 days is a red flag.

Pull this monthly and look at trends. Is your 90+ day bucket growing? Are specific payers consistently in older buckets? Breaking down AR aging by payer, provider, or service type helps you understand where your team is struggling the most and allows you to focus follow-up efforts where they’ll have the biggest impact.

Denial Report by Reason

This categorizes claim denials by payer-provided reason: missing information, authorization required, timely filing, coding errors, eligibility issues.

The value in this report is pattern recognition. Repeated denials for “missing prior authorization” signal a workflow problem. “Coding errors” for a particular CPT code indicate a training need. Review these reasons monthly and focus on your top three denial reasons by volume or dollar amount. Armed with this knowledge, your training will be laser-focused on the issues that are impacting your revenue right now.

Clean Claim Rate Report

Industry benchmark for this stat is above 96% which means 96% or more of your claims should be paid on first submission without edits or appeals.

If you notice a declining clean claim rate, it could indicate one or more upstream problems: registration data accuracy, coding quality, or charge entry completeness. If your rate drops below benchmark (or is not quite at the national benchmark yet), remember this statistic doesn’t live in a vacuum! Pull your denial report to identify what’s causing rejections. When you start examining how your reports work together, you begin to paint a full picture of your revenue cycle management.

Days Not Final Coded (DNFC) and Days Not Final Billed (DNFB) Report

Ideally, coding should happen withing a few days of service and billing should follow immediately. The DNFC and DNFB reports show you which accounts are sitting in limbo – services have been provided but coding has not been finalized, or coding is done but billing is stalled.

High DNFC indicates coding backlogs and high DNFB points to billing bottlenecks. Reviewing these reports monthly helps you keep your revenue cycle moving.

How to Use These Reports Effectively

Set Baselines First

If you have never pulled a report before, your first few months establish your baseline. Don’t expect perfection right away – your goal is understanding where you are today so you can measure whether your future changes are working.

Focus on Trends

One month of elevated denials might be a fluke. Three consecutive months is a trend demanding attention. Monthly reporting reveals patterns invisible in quarterly reviews.

Assign Ownership and Close the Loop

Someone needs to own each report. Charge reconciliation might belong to your billing manager. AR aging to your collections lead. Giving each report and its follow up some clear ownership builds in accountability which means your reports regularly get reviewed and improvements get implemented.

When you’re reviewing your data, make sure to share findings with teams who can fix them. If denial reports show eligibility issues, that’s a registration training need not a provider training issue. Monthly cross-functional check-ins keep everyone aligned, and communication channels opened.

When to Bring in Outside Support

Many healthcare organizations find that building consistent reporting rhythms and knowing what to do with the data is a consistent struggle. It’s not that the reports don’t exist; it’s that internal teams either don’t have time to analyze them thoughtfully or don’t have the expertise to interpret what story the numbers are telling.

This is where outsourcing revenue cycle management services can provide value that goes beyond just processing claims. When you work with an expert RCM team, they’re pulling these reports regularly, spotting patterns across your organization, and bringing their insights about what’s normal versus what indicates a problem worth investigating directly to your leadership.

An experienced RCM company can help you understand which metrics to prioritize for your specific payer mix, specialty, and patient population. They can benchmark your performance against similar organizations and identify opportunities you might not see when you’re focused on daily operations. If that sounds like something your organization needs (even if it’s just for one of your programs or services) we’d love to connect!

Building the Habit

Start simple. Pick three reports from this list and commit to reviewing them on the same day each month. First Monday of the month, last Friday, whatever works for your schedule – as long as it is consistent.

Block 30 minutes on your calendar, pull the reports, note any significant changes from last month, and identify one action item to address. Don’t try to fix everything at once. Focus on the highest-impact opportunity each month and start there.

As the rhythm becomes routine, you can expand to additional reports or deeper analysis. Your goal with great reporting is to build visibility. When you know where your revenue leaks are, you can plug them. By monitoring trends consistently, your team can address small problems before they become big financial losses.

Your EHR might already have most of these reports built in, and learning how to run them and read them regularly arms you with the knowledge you need to protect your revenue. Monthly reporting turns your data into actionable intelligence that keeps your revenue cycle healthy and your organization financially stable.