FQHC BILLING SERVICES
Medical Billing & RCM Service Tailored to Federally
Qualified Health Centers
Essential Reasons to Outsource FQHC Billing
FQHCs offer multiple services and employ various types of medical professionals, making their medical billing particularly challenging. The coding must adhere to the unique requirements given by the Centers for Medicare & Medicaid Services (CMS) particularly for facilities stated to be FQHCs, which is why we have seen great value with outsourcing coding & billing work to experts specializing in medical billings & revenue cycle management (RCM).
With a decade of rigorous and extensive application of our system, we can confidently assure that our services will outperform and thus enhance our client’s profitability. We “scrub” claims for inaccuracies prior to submission, submit per the requirement for each payer or clearinghouse, and track each claim to ensure it is paid. We pursue follow-up denials at no cost to you, and never simply let a difficult claim go unanswered. Med Bridge offers billing services that compress and optimize your center’s income across the entire revenue cycle.
Experienced and HIPAA Compliant
Since FQHCs provide such a wide range of services, it is hard even for medical staff to stay up to date on all the current correct codes — and Medicare codes can be extremely complex. At Evolvex Solutions, we provide expert coders and billers certified in their trade and experienced in FQHC billing services. Plus, all employees go through HIPAA best practices training so that patient information can be handled in a secure and compliant way.
The Challenges of Medical Billing for FQHCs
FQHCs include millions of patients with diverse needs, so coders and billers need to have familiarity with many different codes. Below are just a handful of reasons billing for this type of medical facility is 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.
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. Med Bridge 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
Apart from the regular visit, many FQHCs also provide behavioral health care management and psychiatric consultation as part of service coverage. For this, detailed awareness in both of these special domains and also about respective requirements of CMS regarding visits become very crucial for a medical coder and biller.
Med Bridge Increases Payer Reimbursement and Assures Smooth RCM
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.
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.