Skip to main content

What is FQHC medical billing, and why is it important?

November 4, 2022

Federally qualified health centers (FHQCs) are federally funded health centers that provide medical care for historically underserved areas, ensuring everyone has the right to healthcare services. These facilities provide affordable access to primary and preventative care for patients and qualify for reimbursement through Medicare or Medicaid. 

FHQCs must meet several requirements for not only the services they provide but the way those services are reimbursed. FQHC medical billing can get complicated, as the medical coding rules and guidelines for Medicare and Medicaid are rigid and ever-changing. 

Let’s dive deeper into the nuances of FQHC billing and how it affects your center’s ability to reach its highest potential. 

What is FQHC medical billing and what services does it include?

Because FQHCs are federally funded, it’s important for medical billing and coding to be performed in compliance with the rules set by the Centers for Medicare and Medicaid (CMS) and the Health Resources and Services Administration (HRSA). The services performed at FHQCs must be carefully captured and billed so the facility can receive the necessary reimbursement and continue generating a healthy revenue cycle. 

coronis health fqhc medical billing nurse staff

An FQHC medical billing company does the hard work of medical billing and coding, adhering to the complex requirements involved. These are experienced billers and coders who understand the Medicare and Medicaid requirements—ensuring claims are clean, profits increase, and days in A/R decrease. Beyond FQHC medical billing service, some companies even provide revenue cycle management and financial reporting to identify and correct revenue cycle problems. 

How can FQHC medical billing help your clinic or practice run more efficiently and improve patient care?

Unfortunately, most healthcare teams don’t have the time and expertise to stay up-to-date with the ever-changing Medicare and Medicaid reimbursement requirements. The complicated nature of FQHC medical billing can lead to delays in financial reimbursement, financial errors, and overall team frustration. Accurate FQHC billing is crucial to yielding profits and creating a healthy revenue cycle. Abiding by the CMS and HRSA guidelines and avoiding denied claims allows for consistent net profit and more time to dedicate to patient care. 

coronis health fqhc medical billing expert working at laptop

The time-consuming nature of keeping up with the FQHC billing and coding guidelines can burden your staff. Many facilities handling the billing and coding in-house see poor collection rates and high claim denial rates, leading to lower staff morale, higher burnout, and less time for the most important aspect of your FHQC center—the patients. FQHC medical billing services relieve healthcare staff from the frustration of navigating the rules and regulations and puts the focus back on the patients. 

How does FQHC billing differ from traditional medical billing services?

FHQCs are reimbursed for their services on an all-inclusive model through Medicare and Medicaid. However, FQHCs often struggle to collect fair payment for their services, encountering higher claim denial rates and more lost revenue than traditional healthcare centers operating with commercial insurance. There are many unique aspects of FQHC billing, including:

  • Sliding fee scales
  • Cost-based reimbursement
  • Encounter rates
  • Wrap payments
  • PPS Medicare reimbursement
  • And more… 

All claims for services performed at an FQHC must also be documented with HCP and HCPCS coding that differs substantially between Medicare and Medicaid. These billing and coding differences are constantly changing as CMS releases updates. 

Due to the complicated nature of FQHC billing, it’s vital for FQHCs to closely analyze their revenue cycle and make changes that will support their growth plan. Lost revenue and high denial rates can stunt the growth of these centers, making it imperative to find the root cause of denials and correct them with experienced medical billers and coders to maximize their revenue cycle. 

coronis health fqhc medical workers discussing chart

Questions about FQHC medical billing? Contact us at Coronis Health today!

Coronis Health differs from a typical FQHC medical billing company by providing FQHC and CHC services for not only medical billing and coding, but collections and denial management, revenue cycle management, financial analysis, and reporting. 

We understand the importance of FQHC medical billing being done right. Our highly trained, certified professionals will ensure timely financial reimbursements, an improved clean claims rate, and excellent customer service so you can put the focus back on patient care. 
Contact us today to learn more about what Coronis Health FQHC billing services can do for your team.

Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch