Why Wipfli
Wipfli’s nationwide team understands that you face unique challenges demanding customized solutions.
We’ve served over a thousand clients across the U.S., drawing on those successes in working with rural health clinics, critical access hospitals and other providers to build solutions targeting your exact needs.
We can help you achieve greater financial viability with reimbursement services that take a comprehensive look at your revenue cycle, empowering you to make informed reimbursement decisions, minimize outstanding accounts receivable and accelerate cash flow. And we help you implement the compliance framework you need to help ensure that you obtain full payment for services while adhering to regulations.
We can also take your organization further with digital solutions and strategies that help you reduce costs, improve productivity and better protect sensitive patient data.
Discover how our integrated approach can help you identify and take advantage of the latest opportunities to enhance patient access and expand your services.
Wipfli’s healthcare-specific services can help you optimize your operations and financial performance. We offer services that include:
- Reimbursement services
- Revenue cycle management
- Capital and facility planning
- Physician demand planning
- Strategic planning
Wipfli has decades of experience in supporting healthcare organizations with our outsourced CFO and accounting services. We can add significant financial knowledge to your organization, delivering insights that help you identify opportunities to increase cash flow and optimize your day-to-day financial operations. We also offer vCISO services to help you enhance your IT infrastructure and cybersecurity.
Our industry-experienced audit team understands the specific audit requirements for rural healthcare organizations, helping you get the right audit for your compliance needs.
Increase your digital capabilities and get the tools you need to master your productivity and revenue challenges with Wipfli. Our digital team can support your organization’s:
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Connect with our rural healthcare specialists to discuss strategies for improving financial performance, enhancing operations and supporting long-term sustainability.
Insights and resources
ARTICLE
Digital behavioral health therapy and Medicare opportunity
Behavioral health leaders are facing a familiar, but increasingly difficult equation: Demand is growing faster than the workforce, waitlists are lengthening and adding more appointments is not always financially or operationally realistic. The question is no longer whether organizations need more capacity. It is how to create that capacity without simply asking an already-constrained clinical team to do more. Digital mental health treatment may offer one part of the answer. Used appropriately, these tools can reinforce a clinician-led treatment plan between appointments, give patients another way to engage with care and support a more scalable operating model. Medicare reimbursement makes the opportunity more tangible, but reimbursement alone does not make the model sustainable. Why the traditional outpatient model is under pressure Outpatient behavioral health is labor-intensive. Revenue is closely tied to clinician time, yet organizations are competing for a limited supply of licensed professionals while managing payer rates that may not fully support the cost of recruiting and retaining them. More demand, by itself, does not solve that problem. That is why the strategic question should be broader than “How do we add appointments?” Leaders should ask: Which parts of care require a clinician in real time, which activities can be reinforced digitally and where could technology improve access without weakening clinical accountability? Where digital therapy can fit Digital therapy is most useful when it supports a defined clinical purpose. A clinician still evaluates the patient, establishes the treatment plan and determines whether a particular tool is appropriate. The technology can then support structured exercises, education, symptom tracking or skill reinforcement between visits. This is not about replacing therapists. It is about reserving clinician time for the work that requires judgment, relationship and intervention, while allowing patients to engage with structured elements of care on their own schedule. For the right patient population, this can improve continuity and help a clinician support more patients without simply adding hours to the calendar. Potential applications include structured support for conditions such as depression, anxiety, insomnia, post-traumatic stress and substance use disorders. The specific use must follow the product’s authorized indication and the organization’s clinical protocols. Not every app is a medical device, not every device is appropriate for every patient and not every digital interaction is reimbursable. Medicare creates an opening, not a guarantee Medicare now recognizes services associated with qualifying digital mental health treatment devices, including the supply of the device and related treatment-management work. That is an important change because it gives providers a defined pathway to evaluate. It should not be interpreted to mean that any behavioral health app can be prescribed and billed. Coverage and payment depend on the device, the patient, the professional furnishing the service, documentation, time requirements and other billing conditions. Organizations also need to confirm how their Medicare Administrative Contractor prices the service and whether Medicaid and commercial payers follow the same pathway. Medicare can be a starting point, but it is not a universal reimbursement strategy. Five questions leaders should answer before investing 1. What capacity problem are we trying to solve? Start with a defined patient population, service line or access constraint. A focused use case is easier to evaluate than a broad “digital transformation” initiative. 2. Which patients and treatments fit the model? Establish eligibility criteria, exclusions, escalation protocols and expectations for clinician involvement. Safety and clinical appropriateness have to lead the design. 3. Do the unit economics hold? Model device cost, expected payment by payer, staff time, patient activation, documentation, denials, integration and cybersecurity. The objective is not to claim volume. It is a sustainable care model that improves access and uses clinician capacity wisely. 4. Can the workflow support defensible billing? Ordering, onboarding, time capture, patient communication, device use and continued eligibility must be documented consistently. If those steps sit outside normal clinical and revenue-cycle workflows, the program may add work without producing corresponding value. 5. How will we govern and measure the program? Define accountability for clinical escalation, informed consent, privacy, cybersecurity, vendor oversight, outcomes and adverse-event response. Decide in advance what success means and when the organization will expand, redesign or stop the program. A practical path forward For most providers, the right next step is not an enterprise-wide rollout. It is a disciplined pilot. Select one clinically appropriate population, confirm the device and payer requirements, map the workflow, train the team and monitor access, patient engagement, clinician time, denials and net financial contribution. Digital therapy has real potential to extend care and improve the economics of outpatient behavioral health. But the opportunity will not come from the app alone. It will come from combining the right clinical use case with a defensible reimbursement strategy and an operating model that clinicians and patients can actually use. Read more Revenue leakage in healthcare: How to find and prevent it AI in healthcare finance: Practicality over hype, strategy over speculation 5 reimbursement strategies for rural health clinics
ARTICLE
Rural hospital strategy: Maximizing value for your entire network
Rural hospitals are often essential access points, major employers and important parts of a regional delivery network. Yet within a large health system, their financial contribution can be easy to overlook because their total revenue may be smaller than that of a single service line at a tertiary hospital. That is the wrong comparison. The better question is whether the rural hospital is being used strategically. Is the system preserving local access, directing the right care to the right setting and taking advantage of the reimbursement structures available to qualifying rural providers? The answer is not to move services to a rural location simply because reimbursement may be different. It is to evaluate patient need, clinical appropriateness, capacity, compliance and system economics together. Why rural hospitals require a different strategy Rural healthcare operates with lower volume, a higher proportion of patients covered by government programs in many markets, longer travel distances and persistent workforce constraints. Rural communities also vary widely. A frontier hospital, a regional rural referral center and a hospital located near a metropolitan area do not face the same market conditions. Specialist access is one of the clearest differences. When patients must travel long distances for routine specialty care, they may delay treatment or rely on the emergency department. A coordinated outreach, rotating-specialist, or telehealth model can keep appropriate care local while connecting the rural hospital to the broader health system. For the health system, that rural location is more than a small hospital. It is existing infrastructure, a trusted community presence and a platform for primary care, diagnostics, outpatient services, emergency care and referrals. The strategic value comes from using that platform well. Three reimbursement structures that matter for rural hospitals Rural status by itself does not create a single reimbursement model. The relevant payment methodology depends on the provider type, program eligibility, ownership structure, services furnished, payer and state rules. Three programs deserve particular attention. 1. Critical Access Hospital reimbursement A CAH is a specific Medicare provider type, not a general term for every rural hospital. Qualifying hospitals must meet federal requirements that include rural location, distance or necessary-provider criteria, a limit of 25 inpatient beds, 24/7 emergency services and an annual average length-of-stay requirement for acute inpatient care. Medicare generally reimburses CAHs for allowable costs under a cost-based methodology. That can be advantageous in a low-volume environment, but it does not automatically make every service profitable. Leaders still need disciplined cost reporting, service-line analysis, charge capture and an understanding of how shared costs are allocated across the system. 2. Rural Health Clinic payment An RHC is a federally certified outpatient clinic located in a rural, underserved area. RHCs may be independent or provider-based, and Medicare generally pays qualifying visits under an all-inclusive-rate methodology, subject to applicable rules and limits. The key point is not that an RHC receives the full amount charged. Payment depends on the clinic’s status, the service, the payer and current payment rules. Health systems should evaluate where RHC certification is available, whether the provider-based structure is appropriate and whether operations, staffing, billing and documentation support compliance. 3. The 340B Drug Pricing Program The 340B program allows eligible covered entities to purchase outpatient drugs at discounted prices. For qualifying rural hospitals, it can support access and financial sustainability, but participation brings significant eligibility, registration, recordkeeping and program-integrity responsibilities. Health systems should treat 340B as a compliance-intensive program, not simply a margin opportunity. The right approach is to confirm eligibility, maintain strong oversight and monitor federal and manufacturer developments that may affect the program. Where the opportunity is for rural hospitals The most durable opportunity is to match local demand with services that can be delivered safely and efficiently in the rural community. That may include primary care, infusion, imaging, rehabilitation, selected outpatient procedures, behavioral health, specialty clinics or other services supported by the market. This requires a system-level view. Moving every patient to the tertiary center can create travel burdens, increase leakage and underuse rural capacity. Moving a service to a rural site solely for reimbursement can create compliance and operational risk. The goal is a clinically sound network in which each location has a clear role. Bring specialty care closer to the patient A rotating-specialist model can expand access without requiring a full-time specialist at every rural location. It also strengthens the connection between local primary care providers and the health system’s specialty network. In many cases, consultation, diagnostics and follow-up can occur locally, while more complex interventions remain at the tertiary center. Done well, this model can reduce avoidable travel, improve continuity and create a more predictable outpatient pathway. It also helps the system reserve higher-acuity capacity for patients who truly need it. Use telehealth as care infrastructure, not a future windfall Telehealth can extend specialty, behavioral health and follow-up care into rural communities, but reimbursement rules remain service- and site-specific and continue to change. Current Medicare rules for RHC and FQHC distant-site medical telehealth do not simply mirror the RHC all-inclusive rate, while mental health telehealth follows different requirements. For that reason, telehealth should be evaluated first as an access and workforce strategy. The business case should reflect the current billing rules, technology costs, clinical workflow, patient connectivity and the value of keeping care within the system. Any future payment improvement should be treated as upside, not the foundation of the investment. What health systems should do now? Start with a practical, location-by-location review: Define the role of each rural hospital and clinic within the regional continuum of care. Analyze service-line demand, contribution margin, capacity, referral patterns and patient out-migration. Validate CAH, RHC, provider-based and 340B eligibility, operations and compliance. Review cost-reporting practices, cost allocation, charge capture, coding, denials and payer performance. Identify services that can be delivered locally based on community need, clinical appropriateness, staffing and infrastructure. Build specialist outreach and telehealth models around access and continuity, using current reimbursement rules in the financial model. Evaluate rural facilities with measures that reflect their mission and strategic role, including access, network retention, quality, workforce and financial sustainability. A rural hospital should not be dismissed because it will never produce the same total revenue as a large urban medical center. Its value is different. It can preserve access, anchor the local care network, support primary and outpatient care and connect patients to the broader health system. The opportunity is not to chase reimbursement. It is to build a disciplined rural strategy that aligns community need, clinical delivery, reimbursement, infrastructure and long-term sustainability. Health systems that do that well can strengthen both their rural facilities and the system as a whole. Read more Rural healthcare RCM: Let data analytics improve your financial performance 5 reimbursement strategies for rural health clinics The tech infrastructure that can drive your rural health transformation
ARTICLE
UDS reporting: Turn compliance into strategic value
For federally qualified health centers (FQHCs), the Uniform Data System (UDS) can be a cumbersome burden — a backward-facing, compliance-driven reporting task that ties up critical assets every year between New Year’s and Valentine’s Day, costing personnel hours and operational efficiency. But for health centers interested in a data-driven future, UDS reporting can present a unique opportunity to modernize and even gain critical insights. A smarter approach to UDS reporting leads to enhanced federal compliance for FQHCs, plus improved behind-the-scenes efficiency and improved patient outcomes. What is UDS reporting in healthcare and how is it used? UDS is an annual reporting system through which FQHCs report their clinical and financial data to federal regulators, enabling authorities to monitor healthcare trends, allocate resources effectively and further data-driven decision-making about community needs. Federal UDS reporting is often contemporaneous with analogous reporting to state agencies, on similar or complimentary benchmarks. UDS data is also used to evaluate the performance of health centers, improve standards of care and identify centers of excellence. By providing insights into disease patterns, treatment costs and patient demographics, UDS serves as a vital tool for managing and tracking critical data from healthcare access points nationwide. Traditionally, UDS data has been used primarily for monitoring purposes, with limited direct consequences for inaccuracies or deviations from the norm. However, the landscape is shifting, and there are now more reasons than ever for FQHCs to insist on accurate data, both from an accountability perspective and because of the potential high value of the insights offered through the data. During the COVID-19 crisis, certain grant awards were directly tied to the total number of patients served, as reported through UDS. This allocation method may continue into the future, underscoring the importance of accurate and comprehensive data reporting for FQHCs seeking to secure vital funding and resources. Today, UDS is commonly used to compare and contrast health centers, particularly along the lines of staffing ratios, quality scores, and financial efficiency. It’s become more common for lenders, funders, and regulators to consult UDS data as a way to benchmark FQHCs against one another. Additionally, savvy Boards of Directors often consult their health center’s public data, monitor year-to-date reporting, and seek to engage executives to understand how (and why) data is trending. The challenges behind meeting the data reporting requirements With a strict reporting deadline of February 15, many FQHCs rush at the beginning of the year to allocate resources to collect the necessary data and organize the reporting. If centers haven’t been checking data quality and outcomes throughout the year, it can make for a stressful Valentine’s Day. To effectively address the challenges associated with UDS reporting, it is crucial to first identify the specific pain points within an FQHC’s data collection and management operations. Common hurdles include: Lack of dedicated resources: Many FQHCs don’t have the resources to dedicate personnel to the UDS reporting process. Often, data entry and reporting responsibilities are assigned to staff members whose training is in other areas, leading to potential oversights or inaccuracies. Data silos and fragmentation: In some cases, data may be scattered across multiple systems or departments within an FQHC, preventing a comprehensive view of the organization’s operations and patient population. Technical complexities: Navigating the intricacies of EHR systems, financial software and the UDS reporting platform itself can pose significant technical challenges in getting systems to generate the correct data sets, particularly for organizations with limited IT resources or expertise. Manual data entry and error-prone processes: Reliance on manual data entry and lack of automated processes is a time-consuming process, tying up valuable resources on tedious work that can also introduce human error, compromising the accuracy and integrity of the reported data. Lack of staff training and engagement: Inadequate training and limited staff engagement can lead to misunderstandings or misinterpretations of data collection and reporting requirements, resulting in inaccurate submissions that don’t capture the full quality of an FQHC’s services. Changing requirements: UDS regulations change every year, meaning FQHCs need to annually invest additional resources into keeping up with the latest updates. Identifying these pain points can help FQHCs develop targeted strategies and leverage available resources to address the specific challenges they face, paving the way for more efficient and accurate UDS reporting and a greater benefit for the FQHCs themselves. Building a more effective UDS reporting process How can FQHCs ease the burden of UDS reporting? And what modifications can be put into place to turn the onerous process of data collection and management into a source of added value for the organization? FQHCs can simplify the UDS reporting process and position themselves for success in an increasingly data-driven marketplace by focusing on five critical areas for improvement: Creating a data governance committee: Establish a cross-functional data governance committee that brings together stakeholders from various departments, including clinical, operational, financial and quality teams. This committee should be responsible for overseeing how data is coded, collected and managed, identifying areas for improvement and driving organizational alignment. Technical enhancementsto the system: Conduct a comprehensive analysis of data workflows and map the journey of data from its point of capture to its ultimate destination within the reporting systems. This exercise can help identify system limitations, bottlenecks, redundancies and opportunities to streamline processes. Monthly data analysis: Pull and discuss data every month in order to identify issues and squash them early. Data can be compared against prior-year trends and, in the case of variance, can be tracked and analyzed to determine why the variance is occurring. It’s much easier to proactively address issues than to try troubleshooting late in the year with the February 15 deadline fast approaching. Data quality audits: Implement regular data quality audits to validate the accuracy and completeness of the data being collected and reported. These audits can involve sampling techniques, cross-referencing multiple data sources and leveraging data analytics tools to identify discrepancies or anomalies. Staff training and engagement: Invest in ongoing staff training and engagement initiatives to ensure that all stakeholders understand the importance of accurate data collection and reporting. Additionally, by identifying early in the process who is responsible for what, more tasks can be managed in a timely fashion, and everyone will be working from the same playbook from the start. By addressing these key issues, organizations can begin to transform their once-dreaded UDS workload into a valuable chance for growth and operational improvement. Use UDS data reporting to spark growth Follow these steps so your FQHC can successfully harness data to its strategic advantage. Make UDS a monthly priority by reviewing it regularly with leadership and the board. Include UDS in routine reporting alongside financial and clinical metrics. Benchmark against peers to identify unusual trends or potential issues. Compare UDS data to internal reports and clinician insights to uncover discrepancies. Establish clear data governance by defining a source of truth for different needs across competing systems such as UDS, EHR, payroll, accounting and Population Health System. Treat UDS as an ongoing process rather than a once-a-year burden to drive operational improvements, efficiency and growth opportunities. Turning UDS reporting into value UDS can provide more than just peace of mind for your organization. By shifting to a value-producing approach rather than a compliance-only focus, your organization can derive significant benefits from the annual exercise. Automating and integrating data to improve operational efficiency Manually pulling data together is a time-intensive process that ties up key resources just to meet regulatory deadlines. But shifting to an automated data collection system and implementing integration tools that can pull data from all of your systems can minimize data handling while improving accuracy. This provides value by reducing preparation time and staff costs , while also freeing up resources to focus on patient care or operational improvements. Additionally, real-time access to your data can be used to monitor performance on an ongoing basis, not just during UDS prep time. Turning UDS preparation into a continuous quality improvement cycle UDS preparation at many health centers is reactive, with efforts focused merely on submitting a complete product or on avoiding UDS quality-control questions in a rush to get the process done. But by using the process as a catalyst for ongoing quality improvement, you can have regular visibility into actionable data to monitor improvement in clinical care, financial reporting and operational processes, leading to better outcomes for your organization. Using UDS data to enhance patient care with higher-quality reporting Your data can help create actionable insights that can improve the quality of the care you provide. Your preparations already include reporting on standard clinical quality measures, which matter to funders, your community and — most of all — your patients. UDS provides a valuable opportunity for leadership to monitor these quality measures on an ongoing basis and take steps to improve them before undesirable trends become entrenched. Don’t just consider these isolated reporting activities — this data can be used to make real-time decisions. Improving quality metrics is often tied to reimbursement under value-based care models, and may generate quality incentive payments from payers, so your bottom line benefits as well. Improving staff efficiency and engagement through process standardization UDS preparation can overburden staff, leading to burnout, inefficiency and potential reporting errors. But a standardized process with streamlined workflows for data collection, review and submission can help ensure smoother operations, reduced redundancy and less stressed-out staff. Involve clinical staff in audit readiness programs so they can grasp the link between checking boxes in the EHR, day-to-day care delivery and quality metrics that are ultimately reported publicly. This also leads to a more proactive quality-first culture, decreasing the need for a last-minute scramble to gather and process relevant data come February. Ultimately, UDS offers your health center a wealth of opportunities. It’s up to your organization to determine what that might mean for your operations. How much of a role UDS plays in your day-to-day may differ among organizations, but whatever your desired level of involvement is, it’s important to choose a vision, document it and work toward implementation. Read more 4 workforce strategies for FQHC financial health Improving rural healthcare RCM with data analytics The tech infrastructure that can drive your rural health transformation
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