Wiki TRIBAL FQHC

[mcleereman]

I work for a Tribal FQHC and have some questions regarding procedures not associated with a G code under FQHC guidelines. It has been our directive to split out the procedure codes (for example I&D, wart removal, etc) and submit those to Medicare B. However, when I am researching FQHC guidelines I am seeing conflicting information; most of which indicates those services are simply not billable and reported after the fact as an encounter. I understand there are some specialty considerations for Tribal FQHC and am wondering if this is an exception; to bill to Medicare B. Does anyone have any experience or information on the matter?

 

[rcj0401]

Not on Tribal. We are an FQHC and procedures are just something we provide now to MCR patients and receive no reimbursement for. For my curiousity what would you bill/split out?

 

[baskiles]

I'd be interested in finding out what you would bill/split out as well- mcleereman. We are an FQHC. I'd also like to know from rjc0401--- do you just not send anything to Part B if there's no G code under the FQHC guidelines.

 

[mcleereman]

Not on Tribal. We are an FQHC and procedures are just something we provide now to MCR patients and receive no reimbursement for. For my curiousity what would you bill/split out?

We would split the face to face encounter (e/m) to go to Medicare A and if any services provided that there is not a G code to assign would go to be (for example as I mentioned an incision and drainage). If there is no face to face e/m we would bill the I&D to B. We have stopped doing this but were told previously it was allowable under our FQHC designation, however, have not been able to find anything to support this other than word of mouth.