In the present day, most US medical billing companies face great challenges in terms of managing their revenue cycle and the root cause of it is claim denials. Before reworking the claim, the analysts to have a fair understanding of the payer types, billing nuances and Payer processing ways for FQHC. To do so, they must be well-versed in the FQHC medical billing.
Not many healthcare billing companies provide FQHC billing services to their clients. However, there are offshore vendors who are highly trained in providing FQHC billing services. Medical billing companies can take advantage of these services and streamline their revenue cycle management. Let’s understand what FQHC billing is and how medical billing companies can improve it
What is FQHC?
FQHCs (Federally Qualified Health Center) were established in 1991 to ensure that the underprivileged people who are disadvantaged due to geographical location, of all ages enjoy preventive care services. Healthcare for homeless facilities and community health & migrant health centers are some of the FQHCs. These healthcare centers offer patients who are unable to pay with certain privileges including admission to a local hospital and an insurance plan to ensure continuity of care.
Understanding FQHC Billing:
Unlike normal medical billing claims, FQHC medical billing claims are little bit tricky. Even a minor mistake can result in a large number of claim denials. Based on the prospective payment system model, Medicare and Medicaid reimburse the FQHCs. It is highly essential that medical billing companies submit FQHC medical billing claims with the right CPT, HCPCS, Revenue & appropriate “T” codes to avoid denials. The understanding of Wrap billing concept involving the Medicaid MCO and the Medicaid is essential for obtaining quicker reimbursement.
It was a known fact that back in January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) announced that FQHCs can receive payments for Chronic Care Management (CCM) or general Behavioral Health Integration (BHI) services if they offer 20 minutes or more of CCM or general BHI services to patients. The same was applicable for psychiatric Collaborative Care Model (CoCM) services if medical practitioners offer 70 minutes or more of initial psychiatric CoCM services or 60 minutes or more of subsequent psychiatric CoCM services to patients.
New Updates:
The recent update that came into effect on January 1, 2019 states that FQHCs can be reimbursed for Virtual Communication Services. Medical practitioners become eligible for this reimbursement when they offer at least 5 minutes of technology-based or remote evaluation services to FQHC patients. Also,
- Healthcare practitioners will not be reimbursed if they offer the same medical evaluation and services to a medical condition for which the patient was treated 7 days earlier.
- Patients should not be called in for an FQHC visit immediately after a medical service (within 24 hours or at the soonest appointment available).
To get proper reimbursements for the virtual communication services, medical billing companies should submit their FQHC medical billing claims in the following format:
- The claims should be coded using the HCPCS code G0071. It can be done individually or along with other payable medical services.
- HCPCS code G2012(communication technology-based services) and HCPCS code G2010 (remote evaluation services) PFS national non-facility payment rates.
Solution: With the growing FQHC updates and new healthcare reforms, it is harder for medical billing companies to take care of all the billing needs while keeping the revenue cycle streamlined. The apt solution is to outsource FQHC medical billing to an offshore vendor.
About e-care India:
Not just the basic medical billing, E-care India can also offer its clients with unsurpassed FQHC billing services, charge entry services, payment posting, revenue cycle management etc. This highly-experienced medical billing company has 3 offshore medical billing delivery centers to cater to all the clients’ medical billing needs. E-care’s efficient Disaster Recovery Centre makes sure that the FQHC billing services are carried out even during emergency times. Acting like a virtual back office from India, e-care will continue to provide its endless support 20/6. To know more about e-care and its services, log on to www.ecareindia.com.