Medical Billing Solutions for FQHCs

Posted by Ecareindia on July 5th, 2014

Providing Medical billing solutions for Federally Qualified Health Centers (FQHC) has its unique challenges. e-care India a premier offshore medical billing company consisting of experienced billing and coding professionals completely understands the requirements to provide complete medical billing solutions for Federally Qualified Health Centers.

What are FQHCs?

FQHC’s are community based organizations and are funded under the Health Center Consolidation Act (Section 330 of the Public Health Service Act). They are a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services (CMS) of the United States Department of Health and Human Services (DHHS).

FQHCs should provide their services to all people – with or without the ability to pay for those services. The fee is based on a community board approved sliding scale that takes into account the family income of the patient and family size. FQHCs must comply with Section 330 program requirements. Since they are required to provide services to all patients irrespective of their ability to pay, FQHCs get cash grants from the Federal Govt., cost-based reimbursement from Medicaid and free malpractice coverage under the Federal Tort Claims Act (FTCA).

FQHC Updates in 2014:

Based on the proposed rule issued by CMS, payments for FQHC under Medicare part-B beginning from October 2014, will be in compliance with the statutory requirements of the Affordable Care Act (ACA). CMS proposing payment to FQHC will be on single encounter based per diem rate. The reimbursement rates would also be adjusted based on geographical location as the cost of services varies from one place to another. This will be done using the Geographic Practice Cost Indices (GPCI) already in use to adjust payment under the Physician Fee Schedule (PFS). There will also be differences in rates based on the whether a patient is new to the FQHC or if the patient receives an initial Preventive Physical exam or Annual Wellness exam. The increase in reimbursements for these new patients and the Physical or Annual wellness visits is expected to be approximately 33% and FQHCs will start moving to the PPS (prospective payment system) from October 1, 2014, based on their reporting periods.

Typical Payer mix in FQHCs:

Medicaid represents about 37% of total revenues to a Federally Qualified Health Center and offers payments though Medicaid PPS rate. The payer mix is mainly dominated by Medicaid and Medicare, a considerable volume from Blue Cross and Blue Shield and the rest by other carriers.

e-care’s expertise in Billing for FQHCs:

e-care offers medical billing solutions to FQHCs situated in different states by completely understanding the nuances of dealing with the Federal and State payers in each state. For some States, the denials are handled right on the payer website and the denied claim is converted to a paid claim in few minutes and the checks for the same are released in the next check run from the payer. The payment posting process is also completed very soon and thereby the overall Accounts Receivable is always maintained at a very low percentage.

About e-care:

e-care India assures the above mentioned benefits with total customer satisfaction. With 14 years of experience in the industry, e-care’s 3 offshore medical billing delivery centers have been providing end-to-end medical billing solutions seamlessly to its clients. To know more about e-care and its services, log on to

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Joined: June 20th, 2011
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