The IHCP All RHC and FQHC services are reimbursed per encounter. Federally Qualified Health Centers and Rural Health Clinics Library Reference Number: PROMOD00028 3 Published: November 17, 2020 Policies and Procedures as of October 1, 2020 Version: 5.0 Change in Scope of Services The IHCP understands that changes may occur in the scope of FQHC and RHC services. Many of the Texans they serve are indigent, uninsured and underserved. Coverage and Payment for Federally Qualified Health Centers (FQHC) – April 3, 1996; effective May 3, 1996. This includes (but is not limited to) dentures and orthodontics. At a minimum, the FQHC or RHC must be paid an amount equal to the FQHC and RHC PPS rate. RHC and FQHC Reimbursement Methodology . Servic es eligible for an encounter payment are reimbursed utilizing the facility -specific Prospective Payment System (PPS) rate. APM I – Expires Dec. 31, 2020. The FQHC/RHC should billT1015/U9 (as noted above) for each time the member has a A Rural Health Clinic may be either a permanent location that is a stand alone building or a designated space within a larger facility. CFR section numbers: 42 CFR Part 491 Federally Qualified Health Centers (FQHCs) provide comprehensive health care services to underserved communities. Federally Qualified Health Centers ‹‹FQHCs›› were added as a Medi-Cal provider type in response to the Federal Omnibus Budget Reconciliation Act (OBRA) of 1989. For general RHC and FQHC information, refer to the Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) section in this manual. Rural Health Clinic Billing 101* It’s all about the encounter! The PPS rate is one facility- specific, predetermined rate, regardless of the allowable RHC or FQHC service. FQHC services are the core services defined at … Federally Qualified Health Center Service – A medical, dental or allied health service provided by FQHC personnel and services and supplies incident to such services provided by FQHC personnel. The medical discussion cannot be related to a condition in which the patient was seen at the RHC/FQHC within the previous 7 days, and cannot result in a visit to the RHC/FQHC within the next 24 hours or the soonest available appointment. the patients of the RHC. It would be great to have our own discussion forum here, but I see very few … For the specific reporting period, an FQHC or RHC that elects payment under APM I and participates in the Medicare program is required to submit the following: (FQHC) billing codes and per visit codes. Calling all RHC, CAH, FQHC coders and billers! According to CMS's Medicare Benefit Policy Manual – Chapter 13 – Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services, the interim payment rate is determined by taking the total allowable costs for RHC services divided by the total number of visits provided to RHC patients receiving core RHC services. Some FQHCs offer additional services, such as dental, mental health or substance abuse treatment. The PPS rate is an all-inclusive rate; this means all dental services provided by the FQHC/RHC are included in the provider specific dental PPS rate. RHC and FQHC: All Inclusive Billing Code Sets RHC and FQHC facilities … Here is a link to the CMS FAQ released in December 2018 about Virtual Communication Services. I am a new RHC coder, and have been having a hard time finding information or resources on RHC coding and billing practices. The clinic can also be a mobile facility that moves from one community to another community. 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