Federally Qualified Health Centers (FQHCs) were created in 1991 in order to provide access to health care services in both underserved rural and urban communities. Unlike Rural Health Centers (RHCs), FQHCs are required to provide primary care services across every stage of the lifecycle, offer preventive dental care or have an arrangement with another provider to do so, and have admitting privileges at a local hospital, or present a hospital plan that ensures continuity of care for their patients.
FQHCs are reimbursed on an all-inclusive model under Medicare and Medicaid, although they can bill certain services separately with the appropriate codes and documentation. Other FQHC requirements:
Even though FQHCs are reimbursed with an all-inclusive rate by Medicare and Medicaid, claim forms must be submitted with all the appropriate CPT and HCPCS codes or the claim will be automatically denied.
Few FQHC Billing Specifics
Some common FQHC billing scenarios and the billing guidelines that apply –
A face-to-face encounter (defined as diagnosis, therapy, consultation, surgery) between a patient and physician, PA, nurse practitioner, nurse midwife, clinical psychologist, or clinical social worker in which a covered service is performed may be billed with the following caveats:
A FQHC can bill for the following preventive services:
Diabetes Self Management Training and Medical Nutrition Therapy
Registered dieticians or registered nurses who can provide the appropriate credentials for certification in DSMT can provide these services, which are eligible services provided the following conditions are met:
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