HRSA Patient Visit Billing Expectations

There are many different factors that could impact HRSA’s expectations for billing patient visits. Could you help us make sure our billing procedures are in alignment with their guidelines?

Billing patient visits can be dependent on various things; closing charts by providers, denials due to coding or credentialing issues with insurance companies, and timely filing. It is extremely important that a health center address these issues even before they experience them as it directly impacts revenue. The HRSA Compliance Manual and Site Visit Protocol, Chapter 16 (Billing and Collections) expects that health centers “make and continue to make every reasonable effort to collect appropriate reimbursement for its costs” and “health center has billing records that show claims are submitted in a timely and accurate manner to the third-party payor sources with which it participates”. 

To determine compliance, the expectation is that a health center bills for claims within 14 business days from the date of service. If this isn’t possible, an explanation is required stating the timeline for claims submission and how the health center ensures timely submission of claims to third-party payors. Regardless of billing expectations, health centers should ensure that processes are in place to bill and collect for patient and third-party revenue. To learn more about HRSA’s expectations for Billing and Collections, please visit: https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-16

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