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CHC and FQHC Coding Services

Empowering FQHCs with Accurate and Efficient Coding

At CodeEMR, we pride ourselves on our deep expertise in Federally Qualified Health Centers (FQHC) coding, setting us apart from other medical coding companies. Here’s what makes FQHC coding unique and how our specialized knowledge benefits our clients:

1. PPS Codes for Medicare and Medicaid:

  • FQHCs require specific Prospective Payment System (PPS) codes, such as G0466, G0467, G0468, G0469, and G0470 for Medicare.
  • Medicaid often uses the PPS code T1015.

2. Qualifying Services and State-Specific Programs and Rules :

  • While Medicare rules for FQHCs are consistent across all states, Medicaid programs vary significantly.
  • Our team is well-versed with PPS codes and understands the qualifying services that support their addition.
  • FQHCs often have special programs necessitating additional modifiers, including provider and program-specific modifiers. Our team will develop an SOP (Standard Operational Procedures) or Job Aide tailored to your specific Medicaid plans and unique contracts.

3. Payment Methodologies :

  • FQHCs can opt for different payment methodologies to ensure they receive at least their PPS rate of reimbursement.
  • FQHCs receiving PPS rates for Medicare, we recognize that the definition of a New patient differs from AMA guidelines, and you also receive a higher rate for New patients.
  • We also accurately capture and report the necessary data (CPT/ICD) for cost reports, directly impacting payment rates.

4. MIPS and ACOs:

  • Our coders are knowledgeable about the Merit-based Incentive Payment System (MIPS) and how it influences payments based on quality measures, cost measures, health IT use, and practice improvement activities.
  • In regard to Accountable Care Organizations (ACOs) programs we ensure accurate risk adjustment, which adjusts Medicare or Medicaid capitation payments according to patient diagnoses.

5. CPT II Codes for Quality Measures:

  • CPT Category II codes capture quality measures and can provide additional payments from some insurances.
  • We ensure these codes are accurately applied for HEDIS measures, contributing to quality reporting and potential financial incentives.

6. Fee-For-Service:

  • While FQHCs may use alternative payment methods, fee-for-service remains relevant.
  • Our expertise ensures that every service delivered is appropriately coded and reimbursed.

By leveraging our extensive knowledge and experience in FQHC coding, CodeEMR ensures accurate, compliant, and optimized coding practices. This dedication helps our clients maximize their reimbursements and maintain high standards of care within the unique frameworks of FQHC operations.

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We are a proud sponsor of the National Association of Community Health Centers