FQHC Billing Services
Medical Billing and Revenue Cycle Management Solutions Tailored for the Unique Needs of Federally Qualified Health Centers
Why Consider Outsourcing Billing for Federally Qualified Health Centers?
Federally Qualified Health Centers (FQHCs) offer a broad spectrum of services and employ a diverse range of medical professionals, making medical billing particularly intricate. Accurate coding is crucial, adhering strictly to the Centers for Medicare & Medicaid Services (CMS) specific regulations for FQHCs. Consequently, outsourcing coding and billing to specialists in medical billing and revenue cycle management (RCM) has proven advantageous.
Our system, honed over a decade, is designed to enhance our clients’ revenue. We meticulously “scrub” claims for errors before submission, ensuring compliance with each payer or clearinghouse’s requirements, and diligently track each claim until payment is received. We address denials at no extra cost and do not disregard challenging claims. MedEx MBS offers billing services that optimize your center’s revenue and streamline the entire revenue cycle.
Seasoned and HIPAA-Compliant
Given the wide range of services provided by FQHCs, it can be challenging for medical staff to stay up-to-date with all the correct coding—especially given the complexity of Medicare codes. MedEx MBS offers coders and billers who are both certified and experienced in FQHC billing services. Additionally, all our employees are trained in HIPAA best practices, ensuring secure handling of patient information and maintaining your organization’s compliance.
The Difficulties of Medical Billing for Federally Qualified Health Centers (FQHCs)
FQHCs serve a diverse patient population with a broad range of needs, requiring coders and billers to be well-versed in numerous codes. Here are some of the reasons why billing for these types of medical facilities can be particularly complex:
Per-Diem Payments
If a patient has more than one visit with an FQHC practitioner in the same day, they must be billed as one visit, with the exception of a qualified mental health visit and a medical visit on the same day or if the second visit requires a separate diagnosis, such as being seen once for an illness and returning later that day with an injury. Billers must be attentive to what each visit was for and make sure not to submit separate bills if neither exception applies. Our billers receive ongoing training to make sure that they are familiar with the unique requirements of each specialty or organization they serve.
Off-Site Visits
Qualified FQHC visits can occur not only at approved facilities but also at a patient’s residence, a Skilled Nursing Facility (if covered by Medicare Part A), or even at the scene of an accident. Accurate coding for these scenarios must meticulously document both the medical necessity and the location of the service. MedEx MBS’s medical billing software and training system ensure that billers stay informed about these specific requirements, including variations from state to state.
Mental Health and Substance Use Disorder Coverage
In addition to medical visits, FQHCs may offer behavioral health care management and psychiatric consultations. Medical coders and billers need to be knowledgeable about these specialized services and understand the CMS requirements for each type of visit.
