Federally Qualified Health Centers

FQHCs are required to offer a sliding fee scale based on patient income and family size, ensuring that services are affordable for low-income patients. Proper documentation of patient income and family size is necessary to apply the correct sliding fee discount. Augustus Healthcare Solutions can help you navigate through the nuances of sliding fee Scale.

FQHCs are reimbursed under a PPS rate for Medicaid and Medicare patients. This rate is an all-inclusive per-visit payment that covers a wide range of services. AHCS can help with accurate documentation of services which is critical to justify the PPS rate and ensure appropriate reimbursement.

FQHCs provide a wide range of comprehensive services, including primary care, dental, behavioral health, and preventive services. Some services may be bundled under a single visit, affecting how claims are submitted and reimbursed. AHCS can help you with bundling through services and get maximum reimbursement.

Medicare and Medicaid have different billing requirements, and FQHCs must navigate both systems. AHCS can help with use of specific G codes for Medicare billing, which are unique to FQHCs.

FQHCs may receive capitation payments from MCOs, which are prepaid fixed amounts per patient, per month. AHCS can help with submission of encounter data to MCOs which is necessary to support capitation payments and ensure continued funding.

Many FQHCs receive funding from the Health Resources and Services Administration (HRSA) and must adhere to specific reporting requirements. AHCS can help create a detailed financial report for HRSA which is necessary to maintain grant funding and demonstrate the effective use of resources.

Enhanced reimbursement rates for preventive services such as immunizations, screenings, and well-child visits. Programs for managing chronic diseases may receive additional funding or higher reimbursement rates. AHCS can help you maneuver through the process to get the best reimbursement rates.

FQHCs must comply with federal, state, and local regulations, including HIPAA, OSHA, and other healthcare standards. Regular audits by HRSA and other agencies ensure compliance with program requirements and proper use of funds. AHCS can help with regulatory compliance and audits.

Many FQHCs adopt the PCMH model, which focuses on coordinated, patient-centered care. AHCS can help to achieve PCMH recognition and meet specific care quality benchmarks to acquire incentive payments.

Billing for integrated behavioral health services can be complex, requiring coordination between primary care and mental health providers. AHCS can help you get proper reimbursement by use of specific billing codes.