Advancing Primary Care

Grantee Name

North Country Family Health Center, Inc.

Funding Area

Advancing Primary Care

Publication Date

October 2015

Grant Amount

$32,500

Grant Date:

January 2014 – April 2014

The North Country Family Health Center (NCFHC) in Watertown has been serving Jefferson and Lewis counties since 1971.

NCFHC is virtually the only source of comprehensive primary care in this remote region of New York State, and it successfully became a federally qualified health center (FQHC) in 2012. Although NCFHC is a vitally needed provider, it had experienced financial instability for many years, specifically after becoming a FQHC. In October 2013, its problems reached crisis proportions, and it publicly announced that it would be suspending operations and closing its doors. In response, multiple stakeholders, including the New York State Department of Health, collaborated to preserve the clinic and to ensure there was no disruption of services to NCFHC’s patients, families, and residents. During this time, nearby Samaritan Medical Center became the temporary operator of NCFHC until the health center developed a long-term plan to become self-sustaining. NYSHealth awarded NCFHC a grant to support efforts in strengthening its financial condition and provide resources to address operations and revenue management issues.

Outcomes and Lessons Learned

  • Use external consulting services to address reimbursement and billing issues that resulted from complications in becoming an FQHC, including rebilling projects for approximately 30,000 submitted Medicaid claims and for supplemental wraparound payment for Medicaid Managed Care visits; and
  • Contracted with Visualutions, Inc., for the rebilling project and revenue cycle management consultation, with the following results:
    • Secured an additional $95,000 in revenue and $180,000 in Medicaid Managed Care wraparound payments after correctly processing all eligible Medicaid claims;
    • Decreased the length of time of invoice in accounts receivable from 80 to 50 days;
    • Restructured staff organization for an annual savings of nearly $150,000;
    • Improved the average collection rate by 23%; and
    • Regained operations, and control of the agency was returned to NCFHC’s board of directors.

Temporarily outsourcing NCFHC’s billing operations was effective at recouping lost collection dollars, and this grant gave an immediate return on investment worth hundreds of thousands of dollars. Given the time-sensitivity of the health center’s financial instability, support for this project provided both short- and long-term financial stability for NCFHC, as well as preserved primary care access in a rural area of New York.