Medical Billing

What Is FQHC Billing? Complete Guide 2023

What Is FQHC Billing? Complete Guide 2023

“Medical billing is like a puzzle; a single missing piece will leave it incomplete”

Not everyone can afford proper insurance because of their high costs and multiple complications. But healthcare is a basic requirement for every individual. Here comes FQHC to rescue the underprivileged. Federally Qualified Health Centers (FQHC) are federal organizations that get their funding from the government. They provide accessible and affordable healthcare to the needy. Because it is a government funded organization & helps a huge population with their healthcare services. Maintaining such huge data on a daily basis is very difficult. That is why FQHC billing should be done with precision & by professionals.

FQHC takes care of the documentation of patient's services, submitting claims and getting payments from insurance companies or federal programs. However, involvement of government policies makes it difficult. Because for the sake of improvisations the higher authorities keep making amendments and changes in the policies. Also, continuously changing codes is a huge setback for FQHC billing. There are multiple organizations providing FQHC billing services. Unify RCM is one such name in the field of medical billing, and it has expertise in FQHC billing.

What is FQHC Billing?

FQHC refers to the organizations that are funded by the government. Their main aim is to provide extensive medical care to the people who cannot afford one or have limited financial resources. They follow strict billing guidelines and reimbursement criteria to maintain a proper flow of revenue.

FQHC must also comply with all the healthcare legislation. These regulations include HIPAA, MEDIACARE/MEDICAID criteria and coding standards including CPT, HCPCS and ICD-10.

Guidelines for FQHC

Medical billing has always been a puzzling task for medical practitioners. There are a lot of regulations monitored by the government and certain guidelines issued by the insurance companies. All of this needs to be kept in mind when doing medical billing. It is advised that one should seek professional help. However, there are some key elements that should be considered while doing medical billing.

Complete documentation

  • All the patient's visit, procedures, services or sessions should be documented with precision, leaving no scope for mistakes
  • Medical coders should have complete access to the documentation so that they can align well with the corresponding codes

Check for eligibility

  • Before each appointment one should make sure that the patient is eligible for treatment
  • The treatment or session should be covered in the insurance for smooth billing

Coding and billing should be accurate

  • Complying with the provisions is very important for minimum chances of denial
  • Assign the CPT and HCPCS codes accurately
  • Use modifiers to differentiate between a bundled service or a single treatment

Claim submission on time

  • Claims should be filed on time with either private insurance companies or the government.
  • Paperwork should be complete with all the necessary information.
  • Keep track of the claims so that any issues can be resolved quickly and result in maximum reimbursement

Comply with the regulatory provisions

  • Patient health information (ePHI) should be protected under HIPAA
  • Adhere to Medicaid and Medicare billing policies
  • These are some key elements that should be kept in mind while doing the billing for FQHCs. It will help in completing the paperwork, tracking the payments and increasing the reimbursement.

    How Technology Eases the FQHC Billing Process

    Technology has made everything easier and the same could be done in FQHC billing. With the right tools and techniques FQHCs can improve their accuracy, efficiency and revenue cycle management. Below is a list of technologies that can help in FQHC billing.

    • Electronic Health Record (EHR): Electronic Health Record integrated with the billing software makes the process easy. They can be programmed to match the treatment or session with appropriate coding
    • Dedicating Billing Software: Complete billing software should be made for FQHC. This reduces the chances of manual error and increases efficiency. Also, more analytics could help in analyzing revenue trends and locating areas for improvement.
    • Claim scrubbing: Going through claims to find errors before submission and fixing those errors is known as claim scrubbing. The objective is to increase the chances of reimbursement. This practice helps in tracking and modifying errors instantly.

    This is a list of technologies that could be embedded within your system to improve efficiency. Apart from technology one should invest in training the staff so that the billing process is accurate. The more trained and experienced staff you have, the more are chances of getting reimbursed. They must be trained in managing paperwork and assigning codes. They should be encouraged to attend industry-specific workshops and webinars. However not every practitioner can be well versed with the technology and training requirements. That is why one should go for hiring professionals in the field.

    Professionals in FQHC Billing

    Unify RCM is a reputable firm that takes care of all your medical billing. We are experts in the field and will take the billing burden off your shoulders. Our professionals are well adept with the technologies that can help in increasing your efficiency and improving your revenue cycle. At Unify RCM we are dedicated towards making medical billing a hassle-free task for you. We will take care of all the paperwork and go through it before submitting it for the claim. If any document or information is missing, we will resolve the issue instantly. We have a huge and satisfied customer base with a proven track record of maximum claim reimbursement.

    Unify RCM is always dedicated towards increasing and maintaining your revenue cycle.

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