FQHCs play a pivotal role in ensuring that our vulnerable populations within the United States have access to vital healthcare services. These are inclusive health providers for a diverse patient population. In 2021, 50% of FQHC patients were covered by Medicaid. Although FQHCs exist for patients, not necessarily for profit, there is a cost associated with running these clinics and providing care to patients that every board has to consider.
When a patient lapses, the patient not only loses coverage, the FQHC also loses funding associated with that member. Recent surveys show that nearly one in four Medicaid patients have lost their coverage for at least two months before being re-enrolled. Some patients have lapsed coverage on more than one occasion within the same calendar year. The lion's share of terminations, 70%, are due to avoidable, procedural reasons that the FQHC and patients might not even be aware of until they come in for an appointment – at which point they are faced with the choice of self-pay or forgoing the visit.
The hard truth is that when patients fall out of Medicaid coverage, it has a negative financial impact on clinics. A recent study shows that on average, health centers have lost $595,000 due to redeterminations and spent over 1,600 hours assisting patients with their redetermination paperwork. When clinics are faced with tighter fiscal constraints, it can mean a reduction in services and appointments to already underserved communities.
Ready to assess how much revenue your clinic is missing due to Medicaid lapses?
The potential financial impact of Medicaid lapses on clinic operations makes recovering lapsed patients essential. However, it is not always feasible for clinic staff to stretch their duties even further by adding managing lapsed patients' re-enrollment processes to their duties. This is where PointCare’s Coverage Management tools come to the rescue. We can work with your lapsed patients to ensure they regain access to essential healthcare services, ensuring your clinic can recover funding for covered visits.
By actively addressing Medicaid lapses, clinics can not only recover lost revenue but also ensure continuous care for their patients. It's a win-win situation where the financial health of the clinic supports the health of the community.
Ensure your Medicaid patients remain covered and your clinic thrives. Contact PointCare today to learn how we can help you maintain continuous coverage for your patients and secure your clinic's financial health.
