Revenue Cycle Management

Increasingly, patients seen in safety-net settings are gaining health insurance coverage through Medicaid or commercial health plans. At the same time, insurance coverage for contraceptive services has expanded. An increase in insured patients presents an opportunity for publicly funded family planning providers to access new revenue streams for previously uncompensated care. As a result, safety-net family planning providers have worked to modernize the systems through which revenue is collected from sources of reimbursement – collectively known as revenue cycle management. Despite this progress, many safety-net family planning providers continue to face challenges to successfully collecting revenue from third-party payers. Insurers may be unfamiliar with safety-net providers, or may altogether resist working with them.

NFPRHA's Work

NFPRHA believes that family planning patients should be able to see their provider of choice regardless of their method of payment. To that end, NFPRHA works to ensure its members have the tools they need to strengthen their revenue cycle management processes, enter into contracts with third-party payers, as well as successfully collect revenue from these payers when patients wish to utilize coverage.

 NFPRHA's Position
 

Title X

NFPRHA believes that sustainability for the family planning safety net requires improvements in operations and efficiencies as well as the capacity to obtain additional sources of revenue from public and private third-party payers.

Happening Now 

  • CMS created a new code to report HPV testing for Medicare beneficiaries 30 to 65: G0476 (HPV combo assay, CA screen). Refer to MLNMatters for additional guidance. 

Resources

  • Managing Family Planning Revenue Cycles & workbook (PDF) - Presents a detailed look at how family planning providers are streamlining billing practices as they serve an increasing number of insured patients (April 2013).
  • Coming soon - Revenue Cycle Assessment Tool (PDF) - A tool designed to help health centers identify opportunities for maximizing provider productivity and the efficiency of internal operations.
  • Managing Family Planning Revenue Cycles & workbook (PDF) - Presents a detailed
    look at how family planning providers are streamlining billing practices as
    they serve an increasing number of insured patients (April 2013).
  • Verifying Patient Income in a Title X Setting (PDF) – A fact sheet on operationalizing Title X income verification requirements (April 2016). 

For additional resources & information, access NFPRHA fact sheets and federal comments by issue or read NFPRHA's publications and recent press statements.

 

 

 

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National Family Planning & Reproductive Health Association

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Phone: 202-293-3114  |  info@nfprha.org

© 2011 National Family Planning & Reproductive Health Association