Wiki FQHC Vaccine Billing

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Rperry

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Good Afternoon Subject Matter Experts,

I currently work for an FQHC (Federally Qualified Health Center) can someone point me in the direction of the regulations regarding Billing for Adult Immunixzation Vaccines??

As I have been told the requirements for an FQHC are different than other Outpatient facilities and the claim needs to be submitted with a copy of the Vaccine Invoice for the Adult patient populations.
 
Rperry said:
Good Afternoon Subject Matter Experts,

I currently work for an FQHC (Federally Qualified Health Center) can someone point me in the direction of the regulations regarding Billing for Adult Immunixzation Vaccines??

As I have been told the requirements for an FQHC are different than other Outpatient facilities and the claim needs to be submitted with a copy of the Vaccine Invoice for the Adult patient populations.
Click to expand...

I have billed for an RHC for four years and just moved to billing for a FQHC, which are the same when billing for immunizations (as far as I can tell from research). So, when you bill commercial insurances for adult immunizations, you just bill them as you normally would. When you bill Medicare, flu and pneumonia are taken care of on the cost report, no line items are billed. Hep B is covered for patients who are at high risk for contracting the disease, but payment is included in the encounter rate. I usually bill out all other vaccinations as line items with the expectation that they won't be covered. They are on the claim for coding and cost report purposes.

The only insurance I have ever known to ask for any specific information regarding vaccines is Tricare. (I am in Tricare North region) You have to submit lot numbers, etc. with vaccinations to Tricare.

Hope this helps! :)
 




It is different for FQHC providers. While RHC and FQHC are similar they are not exactly alike. Per the CMS Manual FQHC are to include the flu, pneumo, and Hep vaccines on the claims. See below:


  • Influenza and pneumococcal vaccines and their administration are paid at 100 percent of reasonable cost through the cost report. The cost is included in the cost report and no visit is billed. FQHCs must include these charges on the claim if furnished as part of an encounter. The beneficiary coinsurance is waived.


  • Hepatitis B vaccine and its administration is included in the FQHC visit and is not separately billable. The cost of the vaccine and its administration can be included in the line item for the otherwise qualifying visit. A visit cannot be billed if vaccine administration is the only service the FQHC provides. The beneficiary coinsurance is waived.

For FQHC the vaccines are paid through the cost report, but when the service is a core service (encounter; such as G0467 or G0466), the vaccines are billed as a line item.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf Section 220.3
 
New to FQHC Coding

Chelle-Lynn said:




It is different for FQHC providers. While RHC and FQHC are similar they are not exactly alike. Per the CMS Manual FQHC are to include the flu, pneumo, and Hep vaccines on the claims. See below:


  • Influenza and pneumococcal vaccines and their administration are paid at 100 percent of reasonable cost through the cost report. The cost is included in the cost report and no visit is billed. FQHCs must include these charges on the claim if furnished as part of an encounter. The beneficiary coinsurance is waived.


  • Hepatitis B vaccine and its administration is included in the FQHC visit and is not separately billable. The cost of the vaccine and its administration can be included in the line item for the otherwise qualifying visit. A visit cannot be billed if vaccine administration is the only service the FQHC provides. The beneficiary coinsurance is waived.

For FQHC the vaccines are paid through the cost report, but when the service is a core service (encounter; such as G0467 or G0466), the vaccines are billed as a line item.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf Section 220.3
Click to expand...

Hello!,

I see that you are familiar with FQHC coding, I am new to working at FQHCs. Can you please tell me if we can bill for Telehealth services? I know according to Medicare that we cannot, but do you know if we can by Medicaid guidelines? From what I read in Medicaid manuals they don't specify FQHCs in the Telehealth criteria. I called Medicaid and didn't get a clear answer regarding FQHCs. My facility wants to start billing for it but we are in a metropolitan area, and according to medicare we cannot bill for originating or distant sites.

Also can we bill for prolonged services?

Thank you!

-Lauren Lomax
 
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