FQHC Billing and Coding

HomeFQHC Billing and Coding

Federally Qualified Health Centre (FQHC) billing services covers comprehensive processes as different from normal hospital billing and physician billing due to the varied nature and scope of service provision. Federally Qualified Health Centres are federally funded to deliver medical care for underserved areas that face disadvantages due to various reasons. To provide FQHC billing services one must have a good understanding of the various codes for services provided, such as medical, dental, and behavioral health services, as well as the specific requirements for billing Medicaid and Medicare as the services offered are limited and not extensive.

FQHC services can be provided by:

  • Physicians
  • Dentists
  • Physician assistants (PAs)
  • Nurse practitioners (NPs)
  • Nurse midwives or other specialized nurse practitioners
  • Certified nurse midwives
  • Registered nurses (RNs) or licensed practical nurses (LPNs)
  • Mental health professionals
  • Naturopathic physicians

FQHC billing guidelines must be followed while billing with the FQHC revenue codes listed below and a Healthcare Current Procedural Coding System (HCPCS) code describing the encounter:

  • 0521 – Clinic visit by member to FQHC
  • 0522 – Home visit by FQHC practitioner
  • 0524 – Visit by FQHC practitioner to a member in a covered Part A stay at the SNF (Skilled Nursing Facility)
  • 0525 – Visit by FQHC practitioner to a member in a SNF (not in a covered Part A stay) or Nursing Facility (NF) or Intermittent Care Facility (ICF) or other residential facility
  • 0527 – FQHC Visiting Nurse Service(s) to a member’s home when in a home health shortage area
  • 0528 – Visit by FQHC practitioner to other non- FQHC site (e.g., scene of accident)
  • 0519 – Clinic, Other Clinic (only for the FQHC supplemental payment)
  • 0900 – Behavioral Health Treatments/Services

Choose the right billing and coding services for your FQHC!

Billing and Revenue Cycle Management:

As a FQHC billing and coding company we comply with all the licensing and certification requirements and integrate the latest technology and best practices to provide you with smooth and customized revenue cycle management solutions for your needs.

Denials and Accounts Receivables:

Our teams understand the complexities of denials and ARs and monitor the root causes closely to bring down the percentage of preventable denials and ARs by implementing modular workflow and optimizing the processes.

Provider Credentialing and Enrollment:

Our experts remain abreast of the changes in the regulations of various payer guidelines and bodies that might impact your service provisions to the patients. We monitor, design and employ industry best practices to assist in providing FQHC credentialing services to you.

Reporting and Quality Audits:

We prepare comprehensive reports on the important metrics that aid in regularizing the revenue collection, KPIs, robust process implementation, and other financial metrics. Our quality auditors ensure that at every step of the process quality checks are performed to remove any discrepancies and shortcomings.


Why to choose QWay for FQHC Billing and Coding Service Provider?

QWay teams have a thorough knowledge of the payer processes, billing, and processing rules for claims submission in B-04, ADA, and CMS 1500 forms to the payers, and the following aspects are exclusively taken into account during FQHCs billing:

  • Sliding fee scales
  • Cost-based reimbursement
  • Encounter rates
  • Wrap payments
  • PPS Medicare reimbursement

In FQHC billing, using the correct Medicaid T1015 and Medicare G codes for E&M services is essential for collecting payment from these payers. Patients who receive care from an FQHC never have Medicare as a secondary payer.

Outsourcing FQHC Billing services to QWay Healthcare will ensure you of a professional and comprehensive approach that includes accurate coding, timely submission of claims, proper documentation, and ongoing monitoring of payments and reimbursements. We employ certified and trained healthcare billing and coding specialists who are familiar with the unique requirements of billing for FQHCs to ensure that all processes are being handled correctly and efficiently.

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