FQHC Medical Billing Services
FQHC 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 25 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.
Wrap (Secondary Medicaid) billing:
FQHCs are able to participate in the WRAP Supplemental Payment Program which is approved by CMS. Wrap billing will involve an MCO as primary and Medicaid will be secondary. e-care’s billing staff handling FQHC billing have experience in submitting claims to secondary Medicaid electronically using Practice Management systems that has the “Wrap plug in” or can also submit claims via online in the Medicaid’s website. Wrap payments are faster and can help increasing the collections for the Practice.
Most commonly used Modifiers in FQHC Billing are FP, AJ & EP. EP modifier is for the FQHC billing services provided for Medicaid EPSDT Program (Early and Periodic Screening, Diagnostic, and Treatment Program), AJ is used for the Clinical Social workers who rendered the services and FP used for the Family Planning services. Clients who partner with e-care for FQHC billing services enjoy reduced operational cost of over 45%. Ecare India has developed an internal workflow management tool to handle FQHC billing services which aids in getting the unpaid claims touched duly and thus facilitating incremental revenue.
e-care India also presents a business review deck to its customers monthly on FQHC billing which highlights the varied trends that happen with the payers. Our business analytics will also showcase the road blocks which impact the revenue leakage and thus with the support we receive from our client’s we provide a seamless delivery and our clients enjoy the cost efficiency.