Engagement Pattern · FQHC
Engagement Pattern: How FQHCs get their PPS wraparound right.
What a typical PPS rate report and wraparound reconciliation install looks like for a 330-grant FQHC running multi-MCO contracts.
The starting state
This is the typical state of an operation before we engage. If most of these apply to you, the engagement pattern likely applies too.
- 330-grant FQHC operating medical, dental, and behavioral health visit lines
- Multiple Medicaid MCO contracts, each with different wraparound payment cadences
- Manual wraparound reconciliation done quarterly or annually, often by the CFO directly
- UDS submission errors noticed late, sometimes after the submission window closes
- Sliding fee schedule documentation inconsistent across sites
- 340B program present but not crosswalked to claim modifiers cleanly
The intervention
What a senior ASP-RCM partner runs in the first 30 to 90 days. The audit is week one. The fixes get prioritized by recoverable dollars per week of effort.
- Senior partner runs the FQHC-specific operational audit
- PPS rate file rebuilt from source: state PPS letter + last year's reconciliation + visit-line allocation
- Wraparound reconciliation moved to monthly cadence with MCO-specific tracker per contract
- UDS workflow built around the 30 most-miscoded fields with quarterly internal validation cycles
- Sliding fee schedule + poverty-tier documentation standardized across sites
- 340B claim modifier crosswalk reviewed for compliance + revenue capture
Outcomes we typically see
Ranges from across engagements with this profile. Where industry benchmarks exist (BHCOE, APBA, HFMA, HBMA), we calibrate to those.
- Wraparound payments collected within 30 to 45 days of visit, not quarterly
- UDS submission errors fall to single-digit fields prior to submission
- PPS rate appeals (where warranted) move from anecdotal to documented and timely
- CFO time spent on RCM admin drops as ownership transfers to operational team
- Future PPS rate updates reflect accurately reported visit lines and cost
What to bring to the first conversation
If you want a senior partner to walk through your specific numbers against this pattern, here is what makes the conversation immediately useful.
- State PPS rate letter (current year)
- Last UDS submission
- MCO contracts (or just the wraparound language)
- Last 12 months of wraparound reconciliation
- Sliding fee schedule policy document
Book the conversation
30 minutes with a senior partner.
Free. Written 4-page report. No SDR triage. No obligation.