Did You Know? – Federally Qualified Health Centers (FQHCs)
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- Do federally qualified health centers bill the Part A for influenza and PPV vaccinations?
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Beginning on October 1, 2014, FQHCs transitioned to a prospective payment system (PPS) based on their cost reporting period, in which Medicare payment is made based on a predetermined, fixed amount. CMS outlined PPS claims submission information in Change Request (CR) 8743. Under PPS, if the influenza and pneumococcal vaccines were the only services provided, there is no claim and they are reported only on the cost report. If they were provided as part of an encounter, they should be reported on both the claim and cost report.
Reference:
- CMS FQHC PPS website
- CMS Change Request (CR) 8743
- CMS Frequently Asked Questions (FAQs) on FQHC PPS
Reviewed 12/02/2022
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- Can FQHCs bill for Chronic Care Management (CPT 99490)?
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Effective January 1, 2016, RHCs and FQHCs shall be paid for CCM services furnished to patients with multiple chronic conditions that are expected to survive at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
Claim submission and specific CCM guidelines are available in CMS Change Request (CR) 9234: Chronic Care Management (CCM) services for Rural Health Clinics (RHCs) and Federal Qualified Health Centers (FQHCs)
Reviewed 12/02/2022
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- Where can I find FQHC information on the CMS website? Is there a dedicated website?
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CMS has a dedicated FQHC website that contains PPS and billing information, FQHC FAQs and more.
Reviewed 12/02/2022
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- How are requests for FQHC wraparound payments submitted to CGS?
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Requests for wraparound payments for FQHCs should be sent via email to j15.reimbursement@cgsadmin.com. The needed documentation is contracts with the HMO, the HMO contract number, detailed working trial balance, a listing of the detail of each HMO's charges by patient, date of service and type of service. This information is used to calculate the payment and to update the system, which is organized in the system by contract number.
Reviewed 12/02/2022
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