Navigating New York Medicaid Reimbursement: A Strategic Approach for FQHCs

Like many Federally Qualified Health Centers (FQHCs) across the country, New York’s centers are grappling with increasingly constrained budgets and rising staffing costs, making Medicaid reimbursements more critical than ever to sustaining their services.

New York’s Medicaid system offers a key opportunity, providing FQHCs with the ability to apply for supplemental payments that cover costs beyond the standard reimbursement rate to ensure the FQHC has received the maximum amount it is entitled to. These additional funds are critical when operational expenses outpace initial estimates. By strategically pursuing these payments, health centers can maximize their reimbursement and strengthen their financial footing.

Many FQHCs are also facing increased financial pressures as COVID-19 relief funding has phased out. When combined with the rising cost of staffing and competition for skilled personnel, AAFCPAs advises that health center clients consider a comprehensive approach to improve financial stability—reviewing current reimbursement rates, identifying eligible supplemental payments, and ensuring accurate cost reporting and tracking.

A financial health check is a recommended first step.

For FQHCs experiencing reduced margins or potential losses, a financial health check is a recommended first step. This involves a detailed review of revenue and expenses to pinpoint areas where improvements may be made. An analysis of cost for providing each level of service is crucial. Focus on enhancing revenue cycle management, minimizing claim denials, and ensuring cost reports are prepared effectively to secure the highest possible reimbursement. On the expense side, it is useful to compare cost structures with those of other New York FQHCs and national trends and to evaluate process efficiency, particularly regarding automation.

Technology can play a key role in maintaining financial health. To enhance your organization’s financial stability, start by evaluating how effectively you use current programs and technology. Look for opportunities to automate tasks, implement better revenue management systems, or improve dashboards for clearer financial insights. The goal is to move from a reactive to a proactive approach, so you manage finances more effectively and strategically.

Federal grants and reporting requirements, like the UDS report, are the same nationwide. But New York has its own programs and requirements that FQHCs need to manage. For instance, the Medicaid reimbursement and the specific way cost reports need to be prepared are unique to New York. To remain in compliance and to make the most of available opportunities, it is important to understand these details.

How We Help

Navigating the complexities of financial management in New York’s healthcare sector can be daunting. Are you fully leveraging programs like New York’s Medicaid supplemental payments? Are cost reports prepared accurately to maximize reimbursement for both Medicaid and Medicare? Have you explored all possible avenues to optimize existing revenue streams?

AAFCPAs provides guidance to help FQHC clients maximize reimbursement and margins. We assess their current situation, including reimbursement rates and financial challenges. We then help to optimize revenue streams, analyze cost structures through benchmarking, improve process efficiencies, and ensure compliance with state-specific requirements. AAFCPAs understands the unique financial pressures faced by New York FQHCs and emphasizes a strategic approach to Medicaid reimbursement and overall financial management. By conducting a comprehensive financial health check and leveraging our expertise in federal grant programs and New York-specific filings, we help identify and address the root causes of financial strain. We also implement advanced technology and automation, such as enhanced dashboards and KPIs, to help clients proactively manage their business. Our goal is to strengthen your financial health and support your mission to deliver quality care.

If you have questions, please contact Matthew Hutt, CPA, CGMA, Partner at 774.512.4043 or mhutt@nullaafcpa.com, or Courtney McFarland, CPA, MSA, 340B Apexus Certified Expert™, Partner at 774.512.4051 or cmcfarland@nullaafcpa.com—or your AAFCPAs Partner.