Sazs Health RCM, LLC

Billing Consultation

FQHC

An FQHC, or Federally Qualified Health Center, is an outpatient clinic eligible for specialized reimbursement through Medicare and Medicaid. This designation encompasses Health Center Program award recipients, look-alikes, and specific outpatient clinics affiliated with tribal organizations. It’s important to note that distinct regulations may apply to outpatient clinics associated with tribal organizations when they enroll in Medicare or Medicaid as FQHCs.

1 FQHC 360x245
3 FQHC 360x245
2 FQHC 360x245

Once certified by the Centers for Medicare & Medicaid Services (CMS) as an FQHC, health centers become eligible for various benefits, including :

  • Medicare reimbursement under a Prospective Payment System (PPS), where payment is determined based on a national rate adjusted for the service location. CMS offers a concise overview of the FQHC PPS.
  • Medicaid reimbursement under the Prospective Payment System (PPS) or other state-approved Alternative Payment Methodology (APM). A 2017 issue brief by the Medicaid and CHIP Payment and Access Commission (MACPAC), titled "Medicaid Payment Policy for Federally Qualified Health Centers," provides insights into Medicaid reimbursement for FQHCs.
At Sazs Health’s, we grasp the distinct intricacies involved in billing and coding for Federally Qualified Health Centers (FQHCs). Our seasoned FQHC medical billing team maintains unwavering vigilance and compliance amidst the evolving landscape of governmental/carrier billing and documentation regulations, along with the adherence to compliance requirements set forth by Medicare and Medicaid.