Medical Billing and Revenue Cycle Management Services that Meet the Unique Needs of Federally Qualified Health Centers

Why Should You Outsource FQHC Billing?

Federally Qualified Health Centers (FQHCs) provide a wide range of services and employ a variety of medical professionals, which makes medical billing 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 medical billing and revenue cycle management (RCM).

Our system has been perfected through a decade of application, and we are now able to guarantee that our services will increase our clients’ revenue. We “scrub” claims for errors prior to submission, submit according to each payer or clearinghouse‘s requirements, and then track each claim until it is paid. We follow up on denials at no additional cost, and never just ignore a difficult claim. Medcare MSO provides billing services that maximize your center’s income and streamline the entire revenue cycle.

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Experienced and HIPAA Compliant

Because FQHCs offer so many different kinds of services, it is difficult for medical staff to be aware of all the current correct codes–and Medicare codes can be very complicated. 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 HIPAA best practices to ensure that patient information is handled securely and your organization remains compliant

The Challenges of Medical Billing for FQHCs

FQHCs have many patients with a wide variety of needs, which means coders and billers must be experienced with many different codes. The following 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 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.

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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. Medcare MSO’s medical billing software and training system keep billers updated on these specific requirements, including the differences from state to state.

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.

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Medcare MSO Increases Payer Reimbursement and Assures Smooth RCM

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Our Software Assures Use of the Current Codes

Our innovative approach to FQHC billing services 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.

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Revenue Cycle Management from Start to Finish

In addition to having an expert staff of medical billers to handle claims, we also offer a full suite of RCM services. Payer credentialing, compliance reviews, coverage verification, and annual payer adjustments and payback are just some of the ways we can help streamline your workflow and support excellent patient care.

Medcare MSO’s services increase revenue and our clients also benefit from reduced stress because they don’t have to worry about billing any more. Contact us today to find out how we can help your FQHC succeed.