FQHC MC Billing

Messages
8
Location
Edgewater, MD
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I work for a primary care office and we split bill for our Medicare (CPT office level with G code goes to A) and (Procedure, injectable etc. goes to B). My question is if a procedure is performed for a Medicare patient, can I just bill the procedure without an office level CPT?

tvarga@owensvillepc.com
 
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4
Location
Mableton, GA
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Careful before you write off that procedure!

My org specializes in healthcare economics and reimbursement. We work with many folks who aren't always able to put their hands on available resources when needed. I've attached a document periodically published by Myers and Stauffer (CPAs who work and audit for CMS) that we use as a resource in managing fee schedules for our clients. Per MS, these procedures are considered "encounters". Depending on your offerings, some or all codes should be configured and managed as encounters in your EMR/PMS. They will need to be aligned with the encounter code for government payers and should not be forgotten when filing for the periodic wrap/supplemental payments from traditional Medicare and Medicaid based on your MCOs' reimbursement. These codes would be linked to commercial fee schedules as well.

For the procedures you're writing off, hopefully, your adjustment (write-off) codes have an actionable process flow that allows for optimal, financial reporting of your non-covered charges in accordance with your financial policies and guidelines.

Good luck...
 

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  • 2016 FQHC-RHC Encounter Code Listing.pdf
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Kellyj0h

Contributor
Messages
12
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Billing procedure codes to Medicare Part A for FQHC

Where is this list from and what Medicare G-codes do these procedure codes correspond to for billing?
 

rsager1985

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21
Location
Sacramento, CA
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How are FQHCs supposed to bill secondary insurances after Medicare pays? We're getting a lot of denials because the insurance companies don't seem to understand the PPS system, and they are claiming the PPS codes aren't covered services.
 
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