Delineation of data analytics can be described as geeky, and this brief article is no exception. Yet, for health centers, it's a must read.

Every year in mid-August the Bureau of Primary Health Care releases the prior year's UDS Data.   The data provides a national snapshot of all health centers around finance, patients, visits, etc.   PMG has been reviewing the data for years, looking for information useful to the company and our clients. The past few years have been interesting due to the COVID pandemic and national growth of the health centers program.    

For example, in 2021, health centers generated nearly 10,000,000 additional patient encounters/visits, $3,000,000,000 more in payments and most interestingly $204.00 per paid encounter... a $10.00 per visit increase vs. 2020.  In the end, it would seem the health center marketplace emerged post-pandemic in solid financial shape.  That is good news.    

Section 9D of the reports yields information on charges and payments by payer category (e.g., Medicaid, Medicare, Public, Private Insurance and Self Pay). Interestingly, the data shows no significant shift in terms of percentages by payer vs. data from the preceding year.  Again, boring and geeky.  The data does show weakness in collections with private payers.  That means money left on the table, or to put it another way: health centers gave insurance companies a bonus.  That hurts a little, for sure.   

The average health center collected in 2021 just 58% of private charges vs. Medicaid at 80+% of charges.   In 2021 the average health center payment for private insurance visit/encounter was $183.64.  Reminder: the average health center is paid $0.00 if the claim is denied.  There can be many reasons for claim denials. Some of the most common include less than optimal coding, incorrect claim formats, and front desk registration issues. Another primary culprit: incomplete, inaccurate, or non-existent provider enrollment.    

While well run health centers have strong processes for provider credentialing and enrollment, too many simply do not. This results in missing revenue.  Private insurance is the second largest payment category.   It makes sense to assess today if there's a credentialing and/or enrollment weakness at your health center.  

PMG Credentialing offers a free, high-level assessment for health centers.  Contact us for more information.