FQHC Billing For Behavioral Health And SUD Services

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FQHC Billing For Behavioral Health And SUD
Services


















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FQHC Billing For Behavioral Health And SUD
Services

• FQHC medical billing is similar to outpatient
  private practice billing, but certain
  restrictions apply to ensure the facility remains
  compliant. FQHCs must collect Medicare
  coinsurance, provide after-hours access for
  patients, and offer services on a sliding scale.
  As reimbursement is based on bundled services, it
  is critical for FQHCs to adhere to the strict
  guidelines established by the Centers for
  Medicare and Medicaid (CMS) to avoid denied
  claims.
• Furthermore, the entire billing process, from
  patient registration to collecting unpaid patient
  balances, requires constant attention to keep the
  facility from losing revenue or the ability to
  treat its patients. Lets have a look at the
  guidelines related to FQHC billing for behavioral
  health and SUD services

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FQHC Billing Guidelines for for Behavioral Health
and SUD Services

• Medical billing for FQHCs is more complex than
  billing for standard private practices. The
  billing and coding guidelines for a FQHC are
  strict if not set in stone. FQHC claims submitted
  to CMS with billing and coding errors, such as
  incorrect CPT and HCPCS codes, will be denied.
  These guidelines are in place to ensure that
  coders thoroughly review documentation and use
  current ICD-10 codes. Billers must also consider
  which services can be billed.
• For FQHCs, the below-mentioned simple but
  critical guidelines must be followed
• Only designated healthcare professionals may
  provide services to patients in an FQHC, which
  must be done in person in an outpatient setting.
  Encounters are permitted in a skilled nursing
  facility (SNF) where Medicare Part A applies.
• Mental health providers or social workers may
  consult with family members, but they may only
  bill for services provided to the patient.
• FQHCs bill for preventive services such as annual
  wellness visits (AWV), physicals, and screenings.
  Additional services are billable, such as
  screening electrocardiograms, end-of-life
  planning, and test-result follow-up counseling.
• .

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FQHC Coding Guidelines

• FQHC coding differs from typical outpatient or
  hospital clinic coding in that it requires a
  higher level of specificity that corresponds with
  the PPS. The following are specific codes for
  patient encounters in a FQHC
• G0466 new patient.
• G0467 established patient
• G0468 initial preventive physical exam (IPPE)
  or an annual wellness visit (AWV).
• G0469 mental health, new patient
• G0470 established patient, mental health
• This is only a partial list of encounter codes
  claims must include specific FQHC revenue codes
  and the appropriate HCPCS code. Timing for
  special visits, such as Advanced Care Planning
  (ACP), necessitates using unique CPT codes and
  modifiers to indicate the amount of time spent
  with a patient. Furthermore, incident to
  billing from an FQHC with appropriate coding for
  services rendered by a non-physician provider,
  such as a nurse practitioner or physician
  assistant, is permitted. To avoid reimbursement
  delays, all claims submitted by an FQHC must be
  accurate down to the modifier, from preventive
  medicine to telemedicine.

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Tips for Correct FQHC Billing for Behavioral
Health and SUD Services

• FQHC medical billing and coding can be
  complicated, but you dont want denials or
  collection issues to make that complexity
  impossible. Claim denials and a low collection
  rate can quickly spell disaster for an FQHCs
  revenue cycle, but following these tips can
  provide you with peace of mind and a path to
  improving both your denial and collection rates.
• Concentrate on capturing accurate eligibility
  information to ensure that your staff is
  proficient in gathering correct demographic and
  insurance information on every patient and that
  all benefits are verified before rendering
  services.
• Change to automated tools and use electronic
  health records and billing systems to increase
  centre efficiency.
• Engage patients in open, informative
  conversations about financial responsibility and
  encourage them to use their patient portal to
  inquire about bills.
• Concentrate on your processes ensure that as
  much of your process as possible is automated to
  save time and reduce errors when gathering
  patient information for checking eligibility,
  registration, and coding for an office visit.
• Ensure that your coders and billers are always up
  to date to be aware of compliance changes and
  regulatory updates from CMS to avoid potential
  claim denials.

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Stay up-to-date with 24/7 Medical Billing
Services!

• FQHC billing and coding regulations are
  constantly changing. CMS employs the prospective
  payment system (PPS) to provide a more controlled
  reimbursement rate for rendered services. Still,
  the PPS rates are updated annually to meet market
  variations. FQHC billing experts understand the
  significance of these changes and how they can
  affect coding and claim submission accuracy.
  Thats why contacting the 24/7 Medical Billing
  Services experts is recommended to stay
  up-to-date and ensure correct FQHC billing and
  coding to enhance reimbursements for behavioral
  health and SUD services.
• Even the CMS website has an entire page dedicated
  to FQHCs medical billing and payment information
  ranging from the pandemic to telehealth. Overall,
  these changes can significantly impact a FQHCs
  revenue cycle management outcomes.

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About us

• We are a medical billing company that offers
  24/7 Medical Billing Services and support
  physicians, hospitals, medical institutions and
  group practices with our end to end medical
  billing solutions. We help you earn more revenue
  with our quick and affordable services. Our
  customized Revenue Cycle Management (RCM)
  solutions allow physicians to attract additional
  revenue and reduce administrative burden or
  losses.
• Media Contact
• 24/7 Medical Billing Services
• 28405 Osborn Road, Cleveland, OH 44140
• Phone no / Fax [phone]
• Email us info_at_247medicalbillingservices.
  com

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