Billing for Federally Qualified Health Centers (FQHC) requires a perspicacious approach as the billing and coding guidelines tend to be distinctive compared to billing for other medical specialties. Payments for FQHC Services vary as they set their own fee value for the services which need to be covered under G-Code. Read below to understand the discrete complexities involved in FQHC Medical Billing.
- FQHC has limitations to payments based on the place of service
- Payments are mostly from Medicare Prospective Payment System (PPS)
- All FQHC claims must have FQHC payment code to be processed suitably
- In most cases, payments in FQHC is only for professional services with some exceptions from Medicare
- FQHC payments for telehealth also has some fee involved based on the patient location during telehealth
- FQHC PPS gets updated annually, the latest update was during the COVID 19 including new and expanded flexibilities.
Varying payment policies and regulations in FQHC demand allocation of highly skilled and proficient billers and coders to process FQHC Billing.
Understanding FQHC
Federally Qualified Health Centers as the name goes are qualified health centers providing medical services or primary care services to rural and urban communities. The goal is to provide quality medical services to the underprivileged and homeless.
Billing Strategies for FQHC Billing
There are various limitations under CMS, Medicare and Medicaid for FQHC services to be covered; Billing FQHC claims needs consideration of such limitations accounting the fee value. Discussed below are some billing strategies for improved cash flow in FQHC:
- Ensure your billing and coding team is well versed with FQHC billing guidelines to collect maximum reimbursement
- Focus on keeping your claim denials to minimal or not exceeding the standard quality percentage to drive financial goals consistently
- Establish a strong AR follow-up process strategy and denial management team, constantly working towards collecting all denied and rejected claims within the timeline.
- Monitor for updates and changes in guidelines to make sure related process managers and associated teams are educated on the changes affecting the billing process and payment
- Verify Medicare and Medicaid coverage details thoroughly to determine insurance and patient collection percentage and follow up accordingly.
- Establish an effective Healthcare Revenue Cycle Management covering all the scopes with undivided attention and equal quality.
Outsourcing FQHC Billing
With the variations involved in FQHC Billing resulting in inexplicable complexities and financial deficits, having a streamlined billing process with an expert approach is fundamental. Outsourcing to an established Medical Billing Company with experience in handling FQHC Billing as a core specialty can fetch quality Billing and Improved Revenue flow.
About e-care
e-care is one of the top Medical Billing Companies in India providing end-to-end revenue cycle management services. With our experience and expertise, we service Billing Companies in US, Medical Practices, Physician Groups, Individual practitioners with multi-specialty billing requirements. We have a huge clientele of FQHC and ensure smooth billing and enhanced reimbursement. For FQHC Billing support or to know more about ecare call us today @ 1-813-666-0028 or visit our website www.ecareindia.com