Rural Health Clinics and Federally Qualified Health Centers

Agilbert3

Networker
Local Chapter Officer
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41
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SHREVEPORT/BOSSIER CITY
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Calling all RHC, CAH, FQHC coders and billers! I am a new RHC coder, and have been having a hard time finding information or resources on RHC coding and billing practices. It would be great to have our own discussion forum here, but I see very few posts pertaining to any of our unique practices.

I use the CMS RHC chapter and NARHC website for most of my questions, but if anyone knows of any other useful resources, I'll be more than thankful to hear about them!

Thank you and please respond with any you know of.:confused::confused:
 

natfos6

Contributor
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23
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Rhc

Yes! In same boat. We just took over the rural health clinic and we feel like we were thrown into a fire. We are learning as we go and finding resources is tough!
 
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FQHC Biller/Coding Specialist

I have been coding for a FQHC now for 2 years after coming from a hospital coding background. It took alot to find anything to help me figure this out but google was my best friend :) I also become certified with ARHPC and it helped a whole lot. https://www.ruralhealthcoding.com/default.aspx This is the website you have to pay for the classes but well worth it. I am here if I can help with anything!! maybe we can get a group on Facebook so we can bounce ideas off of each other, just a thought!
 
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Laurenmlomax

Contributor
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12
Location
Rosedale, NY
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New to FQHC Coding

Hi I am also new to working for an FQHC, and I am having a hard time transitioning from a big health system. I am also the only coder here as they have never had a coder before. So I am trying to find ways to generate more revenue by showing what services can be billed that we aren't billing for.

Can FQHC's bill for Prolonged Services with direct patient contact? I read the PDF I put below and it is not included, however they define FQHC visits as "A FQHC visit is a medically-necessary medical or mental health visit, or a qualified preventive health visit. The visit must be a face-to-face (one-on-one) encounter between a FQHC patient and a FQHC practitioner during which time one or more FQHC services are furnished. "

https://www.cms.gov/Medicare/Medica...Downloads/FQHC-PPS-Specific-Payment-Codes.pdf

Are you all billing for Chronic Care Management? I am trying to get it implemented here but they are saying it will be hard to enforce and hard to track. Do you have any tips?
 
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Center for Connected Health Policy, The National Telehealth Policy Resource Center

Hello Agilbert3 Post,

I tried to attach a helpful file here, but I am having issues of attaching the file.

Hopefully, this website (i.e., info@cchpca.org) will be of:) some help for you and your locating "Rural Health Care Telehealth" operating issues. If not, they will direct you to additional pertinent sites for the information you need!
 
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8
Location
Dallas
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New Patients

I have a question in regards to New patient visits. If a provider joins our group and his patients from his previous group or practice follows him, is an FQHC able to bill a new patient visit? I am following CPT guidelines, but my managers say this guideline does not apply to an FQHC, if this patient had never been seen at the FQHC location. I have copied and pasted the below from the Medicare Benefit Policy Manual Chapter 13.
When I read this I still go back to the CPT guidelines. Does the underline not apply to a new provider that has just joined the group, but has seen the patient within 3 years at a previous group not associated with our clinic?

New Patient Adjustment: The PPS payment rate is adjusted by a factor of 1.3416 when an FQHC furnishes care to a patient who is new to the FQHC. A new patient is someone who has not received any Medicare-covered professional health service (medical or mental health) from any site within the FQHC organization, or from any practitioner within the FQHC organization, within the past 3 years from the date of service.

I appreciate any assistance on the above. We are in the process of having a new provider join and his patients will be following him. I need to clarify this as the clinic is setting up to bill new patient visits.

Thank you
Cheryl Rogers
 

Agilbert3

Networker
Local Chapter Officer
Messages
41
Location
SHREVEPORT/BOSSIER CITY
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0
RE ppfingston

Oh I really like the idea of a FB page! You can message me anytime as well. I was able to find a RHC mentor, but she is usually a wait for any answers.
 

Agilbert3

Networker
Local Chapter Officer
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41
Location
SHREVEPORT/BOSSIER CITY
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Croger

I would love to know this as well. I was told this also, but no one has been able to supply a solid reference allowing me to code new patient for a new provider's established patients from previous clinic.
 

hperry10

Guru
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140
Location
Hyannis
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Per CMS they are new patients

I have a question in regards to New patient visits. If a provider joins our group and his patients from his previous group or practice follows him, is an FQHC able to bill a new patient visit? I am following CPT guidelines, but my managers say this guideline does not apply to an FQHC, if this patient had never been seen at the FQHC location. I have copied and pasted the below from the Medicare Benefit Policy Manual Chapter 13.
When I read this I still go back to the CPT guidelines. Does the underline not apply to a new provider that has just joined the group, but has seen the patient within 3 years at a previous group not associated with our clinic?

New Patient Adjustment: The PPS payment rate is adjusted by a factor of 1.3416 when an FQHC furnishes care to a patient who is new to the FQHC. A new patient is someone who has not received any Medicare-covered professional health service (medical or mental health) from any site within the FQHC organization, or from any practitioner within the FQHC organization, within the past 3 years from the date of service.

I appreciate any assistance on the above. We are in the process of having a new provider join and his patients will be following him. I need to clarify this as the clinic is setting up to bill new patient visits.

Thank you
Cheryl Rogers
Hi Cheryl,

I work for an FQHC also. Check out this link.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-PPS-FAQs.pdf


Q6. If my FQHC hires a new physician, and patients from the physician’s previous private practice group
follow the physician to our FQHC, are these patients considered “new patients”?
A6. Yes, because they are new to your FQHC.
 

ntreber

Networker
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59
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It also says "or from any practitioner within the FQHC organization".
If the provider joins the FQHC than the patient from their previous practice has received services from a provider in the FQHC organization.
 

kschulte71

Networker
Messages
38
Location
Hondo, TX
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0
RH-CBS Certified

I have been doing RHC provider-based & CAH billing for appx 8 years and have been RHC Coding and Billing Certified. You can look into this certification through ARHPC (Association for Rural & Community Health Professional Coding) . They have separate certifications for RHC and FQHC. There are also a lot of RHC based webinars available through the organization. I use these annually for competency training for my staff of 12 as well as the coders in our HIM department. I do not mind anyone reaching out to me for questions regarding RHC billing (I do not have experience with FQHC). I will help with anything that I can.

Kellie Schulte, RH-CBS
Medina County Hospital District
Hondo, Texas
 

876asmith

Contributor
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10
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I am in!

I am in the same boat. This is great. I am the only coder at our facility and it is a mess. Trying to get things cleaned up, but this is my first job. I am very overwhelmed.
 

Tlockley

Contributor
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17
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Billing for FQHC

Hello! I like many of you are new to billing/coding for a FQHC. Any tips, or information on billing would be truly appreciated. A few questions that I have are as follows:

1. Do you bill Medicare on UB04's with a G-code and the E/M code with $.01?
2. What system is your facility currently using for billing?
3. Does your facility do telehealth and if so are you being receiving revenue on charges billed?
4. Is there a group that I can join to learn more about FQHC facilities billing/coding?
5. Where can I find examples to ensure that I am billing/coding things properly for the FQHC.

Any information is truly appreciated.

Thanks in advance!!
 

kschulte71

Networker
Messages
38
Location
Hondo, TX
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0
Billing for FQHC


1. Do you bill Medicare on UB04's with a G-code and the E/M code with $.01?
2. What system is your facility currently using for billing?
3. Does your facility do telehealth and if so are you being receiving revenue on charges billed?
4. Is there a group that I can join to learn more about FQHC facilities billing/coding?
5. Where can I find examples to ensure that I am billing/coding things properly for the FQHC.


Go to the website https://www.ruralhealthcoding.com/default.aspx for more information. You can become Rural Health Coding and Billing Certified through this program and there are a lot of great tools to assist you in your questions.
 

BethUnkel

Networker
Local Chapter Officer
Messages
26
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0
Billing for FQHC


1. Do you bill Medicare on UB04's with a G-code and the E/M code with $.01?
2. What system is your facility currently using for billing?
3. Does your facility do telehealth and if so are you being receiving revenue on charges billed?
4. Is there a group that I can join to learn more about FQHC facilities billing/coding?
5. Where can I find examples to ensure that I am billing/coding things properly for the FQHC.


Go to the website https://www.ruralhealthcoding.com/default.aspx for more information. You can become Rural Health Coding and Billing Certified through this program and there are a lot of great tools to assist you in your questions.
kschulte71 - I became RHC certified through the company that you posted. Are there any webinars that you suggest for Nurse Practitioner billing? I am having difficulty in that area. Thank you in advance!
 

Tlockley

Contributor
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17
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kschulte71 - I became RHC certified through the company that you posted. Are there any webinars that you suggest for Nurse Practitioner billing? I am having difficulty in that area. Thank you in advance!
Thanks! I just recently went to a conference for Rural health and Community Center Coding and it was very helpful. Thank you for your respons!
 

kschulte71

Networker
Messages
38
Location
Hondo, TX
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0
kschulte71 - I became RHC certified through the company that you posted. Are there any webinars that you suggest for Nurse Practitioner billing? I am having difficulty in that area. Thank you in advance!

This is an area we are having issues with as well. The previous person that was in my position had the staff billing under the supervising physician instead of the mid-levels but this is now being questioned by our CEO and VP. Trying to find documentation to support either. Please post if you find anything.
 
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This is an area we are having issues with as well. The previous person that was in my position had the staff billing under the supervising physician instead of the mid-levels but this is now being questioned by our CEO and VP. Trying to find documentation to support either. Please post if you find anything.
What state are you located in? I work in an FQHC in Alaska and NP's are able to treat, prescribe, etc as normal providers. We don't have an issue with being reimbursed for them except occasionally from insurance plans outside of AK. We have a scope of practice appeal drafted for this reason that includes the AK laws that allow NP and PAs to practice independently of MDs.
 
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