FQHC Billing Services Provided by Medcare MSO

Federally Qualified Health Centers (FQHCs) provide a wide range of services and employ a variety of medical professionals, which means medical billing can be especially complex. Coding must be done exactly as specified by the Centers for Medicare & Medicaid Services (CMS) special rules for facilities designated as FQHCs, so it has proven beneficial to outsource coding and billing to professionals who specialize in revenue cycle management (RCM).

We are trained on HIPPA best practices

Medicare codes can be very complicated, and because FQHCs offer so many different kinds of services, it is difficult for medical staff to be aware of all the correct codes. Medcare MSO provides coders and billers who are not only certified, but also have experience providing FQHC billing services. Every employee is also trained on HIPPA best practices to ensure that patient information is handled securely.

The Challenges of Medical Billing for FQHCs

An FQHC sees many patients with different needs, which means coders and billers need to be experienced with many different codes. These are just a few of the reasons billing for this kind of medical facility can be so 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 the visits being 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.

Off-site visits

Qualified FQHC visits not only take place at approved facilities, but may be at the patient’s residence, a Skilled Nursing Facility (if covered by Medicare Part A) or even the scene of an accident. The coding for any of these situations must carefully document the medical necessity and location.

Mental health and substance abuse coverage

In addition to medical visits, FQHCs may also provide behavioral health care management and psychiatric consultation. Medical coders and billers must be familiar with these additional specializations and the CMS expectations for each type of visit.

Medcare MSO Increases Payer Reimbursement and Assures Smooth RCM

Our software assures coders have the correct codes

Our innovative approach to medical billing starts with our proprietary software that assures coders have the correct codes including all the latest updates. It picks up the billing cycle when the patient first makes an appointment and streamlines the entire process until the claim has been paid.

We will submit claims and manage any rejections

In addition to having an expert staff of medical billers to scrub and submit claims, then manage any rejections or denials, we also offer payer credentialing, compliance reviews, and annual payer adjustments and pay back.

Medcare MSO’s services increase revenue by eliminating lost and rejected claims, so our clients benefit from more income and reduced stress because they don’t have to worry about billing any more. Contact us today to get a free demo.