Federally Qualified Health Centers (FQHCs) Billing Services

The healthcare industry has been through a whirlwind of changes, leaving healthcare leaders to navigate challenges from increasing costs, complex medical billing and coding regulations, and shifting payer requirements. For Federally Qualified Health Centers (FQHCs) in particular, financial stability is crucial as they operate under tight budgets, while still needing to provide high-quality patient care to medically underserved areas and populations. Due to their status as a federally funded organization, FQHC medical billing and coding requirements are often challenging to fulfil. Their patient population is largely uninsured, which in turn means that the accounts receivable department is unable to run the same way as other healthcare entities.

As an FQHC billing and coding company, 3Gen Consulting understands that FQHC billing and coding must be performed in compliance with regulations set by the Centers for Medicare and Medicaid (CMS) and the Federal Health Resources & Services Administration (HRSA) and offers comprehensive FQHC medical billing solutions tailored to meet these needs. Our FQHC billing services keep up with the ever-changing rates and rules, so you don’t have to. From handling multiple payers to ensuring services rendered are accurately captured, coded, and billed, our services are designed to streamline your FQHC revenue cycle management and optimize financial performance.

Pro Tips for FQHC Billing Services

FQHCs have specific billing and coding guidelines that differ from other provider types. Here are some essential strategies to manage and optimize the FQHC billing process effectively.

Patient Encounter Codes

FQHCs use unique codes to identify various patient encounters, including new and established patients, and annual wellness visits.

Dental Codes

In addition to medical care, FQHCs also provide dental services, which require knowledge of CDT (Current Dental Terminology) codes.

Sliding Fee Scale

FQHCs offer sliding fee scales based on the patient’s ability to pay, adding complexity to the revenue cycle process.

Medicare Billing & Claims Processing

FQHC Medicare claims are processed by Part A and filed on an institutional form (UB-04), unlike non-FQHCs that bill Part B on a HCFA form.

Understand Compliance Requirements

FQHCs must remain compliant with HRSA & CMS guidelines, including annual PPS base payment rates and UDS reporting.

Telehealth & Behavioral Health Requirements

FQHCs must understand the nuances of billing and coding for mental health services furnished through telehealth by its practitioners.

Our FQHC Revenue Cycle Management Services

FQHC medical billing is complex, with nuances that require attention to detail and a deep understanding of the ever-evolving regulatory landscape. At 3Gen Consulting, our certified coders, billers, and auditors specialize in the entire payment cycle, offering FQHC billing services tailored for Federally Qualified Health Centers. We ensure precise coding, accurate documentation, and compliance with federal and state standards, helping to optimize reimbursements and support sustainable, compliant practices.

Eligibility Verification & Prior Authorization: Our team verifies patients’ coverage and benefits and obtains prior authorization, if required, before services are rendered.
Patient Demographics Entry: Our team collects and tracks patient demographics for FQHCs to ensure patient charts are precise and reliable.
FQHC Coding & Coding Audits: Our certified coders and auditors ensure accurate FQHC codes are utilized to reflect encounter details and specialized services rendered.
Charge Entry & Claims Submission: Our team assigns appropriate charges once charts are coded and submits claims promptly, ensuring they meet payer-specific guidelines.

Payment Posting & Reconciliation: Our team enters payments received in the FQHC billing system and compares financial records with bank statements for accurate accounting.
Accounts Receivable & Denial Management: Our accounts receivable associates assist FQHCs to improve cash flow, reduce write-offs and proactively address denials.
Clinical Documentation Improvement: Our clinical documentation specialists review medical documents and bridge any gap between documentation and coding for completeness.
Payer Contracting & Fee Negotiations: Our payer contracting team understands the importance of including key requirements enforced by HRSA for successful contract execution.

The 3Gen Advantage

At 3Gen Consulting, we partner in your growth and support your goal of ensuring your patient population remains healthy. We understand that FQHCs are working on tight budgets and are consistently looking for ways to improve revenue operations. We analyze data, identify gaps, and implement effective FQHC billing strategies to ensure claims are processed efficiently. Still not convinced? Here are some additional reasons to highlight the 3Gen FQHC billing services difference.

Deep Domain Expertise

Our certified professional coders have extensive experience in FQHC coding, ensuring optimal and accurate medical coding while reducing claim denial rates and increasing reimbursement rates.

Comprehensive Audits

Our certified auditors help FQHCs minimize risk caused by improper documentation and inaccurate billing. We provide formal feedback with findings from audits to both providers and management.

Customizable Provider Education

We educate providers along with coding and billing staff on the latest coding and documentation guidelines to keep Federally Qualified Health Centers current and compliant.

Coding & Billing Assistance Program

Our Coding and Billing Assistance Program provides flexibility, allowing clients to engage certified professionals for help with FQHC billing and coding questions as needed.

Tailored Solutions

With our years of experience in the healthcare industry, we understand the unique needs of FQHCs and provide customized services to ensure financial stability and growth.

Performance Driven Approach

We track key performance indicators to ensure your FQHC revenue cycle management is efficient and effective. Our workflows ensure you reap the benefits of improved cash flow, reduced costs and enhanced compliance.

Frequently Asked Questions

What is FQHC billing?

FQHC billing refers to the specialized process of managing claims and reimbursements for patients treated by providers at Federally Qualified Health Centers, which caters to medically underserved areas and populations.

What are FQHC codes?

FQHC coding is complex and makes use of multiple coding standards including CPT, HCPCS, and ICD. The FQHC codes utilized should accurately reflect patient encounters, qualifying visits and any procedure. Coders must also understand the importance of diagnosis coding, when an FQHC is part of an ACO.