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Hello, I am a Project Officer for the Health Resources and Services Administration under the Department of Health and Human Services in Rockville Maryland. My job is to monitor Federal funding for Federally Qualified Health centers or FQHCs. FQHCs are community health centers that will treat patient based on a sliding fee scale and will not turn away any patient regardless of their ability to pay. I make sure the grantees or health centers are compliant with our 19 program requirements. Some of those health centers receive different funding streams for Homeless Patients, Community Health Center Patients, for Migrant Farmers and even Public Housing. Most of the funding is based on the location of the clinic whether it's rural, urban or even frontier and based upon what percentage of patients fall within each category. I have some health centers in San Francisco, who only receive homeless dollars due to the large percentage of homeless in SF. Some of my rural Health Centers up in Norther California receive migrant farmer dollars due to the population they mostly treat. Those health centers that receive multiple revenue streams can afford to treat more patients, but also need to report on the number of those patients treated. We use a system called UDS or Unified Data System, which tracts all patient numbers, visits, diagnosis, race and several other demographics. These centers who are Federally qualified, can receive reimbursement rates or PPS rates or Perspective Payment System, which allows the health centers to be reimbursed for services offered to those with no insurance or those paying on a sliding fee scale based on the Federal Poverty Level by assigning a fixed payment rate to specific treatments. In a Retrospective Payment Plan, a provider will treat a patient and submit an itemized bill to an insurance company detailing the services rendered. The insurance company, in turn, may approve or deny payment for the treatment or portions thereof, but healthcare providers generally get paid in full for the amounts they bill (Eassa, 2017). I try to inform my centers on different funding incentives or entitlements, so that they are not only relying on CHC Federal dollars. Some of those entitlements of being an FQHC are the 340-B pharmacy program, vaccinations for children, Ryan White funding for HIV/AIDS and the National Health Service Corps.

Reference:

Eassa. A. Jul 20, 2017. Technology and Telecom

Article: What Are the Differences Between a Prospective Payment Plan and a Retrospective Payment Plan?