FQHC Medical Billing Services

Federally qualified health centres provide comprehensive healthcare to people who do not have the ability to pay, disadvantaged due to their geographical location or for any other reasons like social status, race, religion etc. The services offered are limited and not as extensive when compared with a typical hospital setting. However, based on the parameters defined by each state Medicaid agency, eligibility and payment will vary for the services offered in a federally qualified health centre.

FQHC Medical Billing:

Handling FQHC medical billing requires thorough knowledge of how the payers Medicare and Medicaid process the claims for FQHC. The Health Maintenance organizations (HMO) and Managed care organizations (MCO) also hold a greater percentage of the payer mix in FQHC billing. e-care India’s billing staff, who has experience more than 23 years, understand the billing and processing rules to submit claims in UB-04, ADA and CMS 1500 forms to payers depending on the type of services offered. FQHC provides Medical, Dental, Behavioural health, Chronic care management and also offers counselling services. Though there are different types of FQHC’s, e-care India majors in servicing clients pertaining to Community health centre.

In FQHC medical billing, the appropriate Medicare’s G code for E & M services and the Medicaid’s T1015 usage is critical for obtaining revenue from these payers. The G codes are never billed to the secondary. Medicare is never a secondary payer for patients who receive care from FQHC. The Payers will pay the claim based on PPS rates (Prospective Payment System) that came in to effect from Oct 2016.It is also good to note the reimbursement rates for Chronic care management and General behavioural health integration has been increased from the year 2018. FQHC’s need to submit cost reports to Medicare annually to ensure uninterrupted payments from them.