The Patient Protection and Affordable Care Act (PPACA) clearly states the current Medicare payment system for Federally Qualified Health Centers (FQHCs) will change to a new Prospective Payment System (PPS) in 2014. Beginning January 1, 2011, claim submission requirements for FQHC services changed based on PPACA mandates.
When billing Medicare services dated on or after January 1, 2011, FQHCs must report all pertinent services provided and list the appropriate Healthcare Common Procedure Coding System (HCPCS) code for each line item, along with revenue codes for each FQHC visit. If service lines do not contain valid HCPCS codes, the claim will be returned to the provider, except for those revenue codes that do not permit HCPCS code reporting. When claims service lines contain a valid HCPCS code but not a revenue code, the claim will be returned to the provider. Until the FQHC PPS is implemented in 2014, the Medicare claims processing system will continue to make payments under the current FQHC interim per-visit payment rate system.
Please note that the updates provided in Change Request 7038 (CR7038) and detailed in Medicare Learning Network’s MLN Matters article MM7038 do not affect claims for supplemental payments to FQHCs under contract with Medicare Advantage Plans. In addition, preventive services covered by Medicare for beneficiaries were expanded effective January 1, 2011.
For FQHCs to respond to these changes, extra effort may be required for organizations to update or modify practice management systems or claims submission processes. In addition, expanded billing and coding training for clinicians and billing staff may be necessary to address changes that could affect your organization’s ability to receive appropriate reimbursement.
Additional details of CR7038 can be found in the attached MLN Matters article and with information provided by your respective fiscal intermediary or Medicare Administrative Contractor.
If you need additional assistance, please contact your BKD advisor or click on one of the photos below to email one of our community health center professionals.