Case Study

HFS Consultants’ Expertise in FQHC Requirements Saves Los Angeles Area Health Clinic


SITUATION

Central Neighborhood Health Foundation is a Los Angeles area clinic that has been providing outpatient services to the under served for more than 40 years. In order to provide financial security for the clinic, its founder, Dr. Bassett Brown, along with his team, applied for and gained approval as a Federally Qualified Health Center (FQHC), which allots state and federal dollars to clinics that serve a large number of Medicaid and uninsured patients. While FQHC status was obtained to strengthen Central Neighborhood’s finances, it almost led to it having to shut its doors.

SOLUTIONS

The intricacies and complexities of the necessary paperwork and documentation related to the FQHC program, as well as lack of knowledge about Medi-Cal’s billing and reimbursement requirements, put Central Neighborhood in a dire financial situation.

Dr. Brown sought help from the California Health Care Foundation’s community health center experts who recommended HFS Consultants’ Steve Rousso because of his experience working with community health centers and FQHCs.

Rousso reviewed the clinic’s documents and determined that necessary paperwork had not been submitted, and it had not been properly enrolled as a Medicare FQHC provider. He also identified state programs that had not been accessed and could have achieved revenue. Rousso determined that Central Neighborhood’s lack of knowledge about FQHC rules had cost the clinic an estimated $500,000 to $750,000.

"The devil truly is in the details, especially after you’ve been approved as an FQHC. There is no handbook for all the requirements and tasks, and no instructions. So if you don’t have the expertise, you are almost certainly going to get in trouble."

-Steven Rousso, HFS Consultants, Principal, Chairman of the Board

RESULTS

Rousso worked with Central Neighborhood to correct and re-submit missing documentation to Medicare, Medi-Cal and other state agencies in order to recover lost revenue. He helped the clinic set new provider rates and clarify its Medi-Cal and managed care utilization and reimbursements. Dr. Brown says he is now hopeful for the clinic’s financial future.

The complete story of Central Neighborhood’s history and how HFS Consultants helped it to handle the complexities of the FQHC program are revealed in a comprehensive article, The Clinic’s Tale: Chasing FQHC Status Not for the Faint-Hearted.

"Steve Rousso had the knowledge on what to do and the connections with some of the right people to see it through to successful completion. Without his help, our new clinic would not have been possible. Steve seems to always be ale to come up with the answer."

-David Green, CEO, El Centro Regional Medical Center

 


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