Wiki FQHC Billing

[apilbin]

When coding and billing for an FQHC do you follow the Medicare Benefit Policy Manual Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services for all payers or just Medicare and Medicare Part C plans? I understand we don't bill FQHC "G" codes to receive our encounter rate to all payers but currently I'm looking at section 40.4 "If an RHC or FQHC furnishes services to a patient who has had surgery elsewhere and is still in the global billing period, the RHC or FQHC must determine if these services have been included in the surgical global billing. RHCs and FQHCs may bill for a visit during the global surgical period if the visit is for a service not included in the global billing package. If the service furnished by the RHC or FQHC was included in the global payment for the surgery, the RHC or FQHC may not also bill for the same service."
and question if we have to follow this for all payers.

 

[cjtown]

In reference to "if you bill MA plans with G codes", it depends on the contract you have with the MA plan. If in negotiation the MA plan agreed to pay the Medicare PPS encounter rate, then you do use the G codes. If they have not, then you do not include them on the claim.

We don't normally have patients in a global billing period, so I cannot actually comment from an FQHC standpoint, but if you are seeing a patient who had surgery, but the reason for visit to the FQHC is HTN, that is outside the global billing parameters. If they are being seen for a wound check or removal of sutures that would be within the global period.

Hope this helps
Carla