Written comments were accepted through november 22, 2016. Please refer to the supplemental instructions article sia. In november 20, cr8504 updated chapter of the medicare benefit policy. Evaluation of cmss federally qualified health center fqhc advanced primary care practice apcp demonstration. Rural health clinicsfederally qualified health centers pdf chapter 9 crosswalk pdf chapter 10 home health agency billing pdf. To navigate through the ribbon, use standard browser navigation keys. This field is required if services were provided in an inpatient hospital setting. The texas medicaid provider procedures manual is the providers principal source of information about texas medicaid. Valueoptions maryland will accept npi numbers that are registered with mmis ii. Federally qualified health center billing 100 questions. Coding and billing guidelines for psychiatry and psychology.
Fqhc lookalikes fqhclals, that have been identified by health resource and. Fqhc s must serve an underserved area or population, offer a sliding fee scale, provide. Every effort has been made to ensure this guides accuracy. Fqhcs that have bh in their scope of work may use billing codes for bh services that are specified in the fqhc behavioral health allowable medicaid billing codes table attachment a. Effective october 1, 2010, states were required by the centers for medicare and medicaid services cms to incorporate all national correct coding initiative ncci methodologies into their systems for processing medicaid claims. The compliance manual also addresses hrsas approach to determining eligibility for and exercising oversight over the health center program and details the. For billing codes to be used by fqhcs and rhcs providing cbas, refer to the rural health clinics rhcs and federally qualified health centers fqhcs. Hospitalization dates if the services on the claim were provided in an inpatient hospital setting, enter the admit date.
Cms does not require a specific form or format for the certification as long as a physician certifies that the five certification requirements are met. This first step must be taken by the fqhc and they will be required to provide the cms certification letter at a later date. Chapter 516028 costbased clinic fqhc, ohf, rhc services. Provider application and agreement forms updated 12017. Federally qualified health centers 1 washington apple health medicaid federallyqualified health centers fqhc billing guide july 1, 2019 every effort has been made to ensure this guides accuracy. Key differences between fqhcs and rhcs physicians practice. Evaluation of cmss federally qualified health center. Summary of comments and hrsa responses on the draft health center program compliance manual. Choose the application that is specific to your provider type. Rural health clinic billing 101 its all about the encounter.
The rhc or fqhc treating provider may be a primary care physician, np, pa, or certified nurse midwife. For additional information see the cms iom, publication 100. The defining legislation for fqhcs under the consolidated health center program is section 1905l2b of the social security act. Transmittal 20, dated july 30, 2010 is being rescinded and. The medicare global billing requirements do not apply to rhcs and fqhcs, and global billing codes are not accepted for rhc or fqhc billing or. For rural health clinics and federally qualified health centers, the amount the patient pays. Cms administers the medicare ehr incentive programs, and the oregon health authoritys division of medical assistance programs administers the medicaid ehr incentive program. Federally qualified health centers provider manual chapter twenty. The cms1500 will be the standardized across plans and products. Cms internetonly manual, publication 4, medicare claims processing manual, chapter 12. The fqhc may contact any member of the hcrd staff listed at the end of this manual in appendix a. Rates published are effective as of the first day of the rate semester october 1st.
A providerbased ccn is not an indication that the rhc has a. Eligible professional manual for federally qualified. Federally qualified health center fqhc preventive primary services that are not covered. An fqhc is a federally qualified health center, which means you have to bill based on specific medicare guidelines that are set up for fqhcs. Policies governing feeforservice clinics are set forth in chapter 5160 of the administrative code. If you are revalidating your enrollment, please select the revalidation check box on the application. Providers must choose between the medicare and medicaid incentives. The complexity of healthcare can make operating a regular physician practices at times a challenge.
State of new jersey department of human services division. Effective january 1, 2016, acp is considered a facetoface service between a practitioner and a patient on advance directives and it is a standalone billable fqhc visit. All discontinued manuals no longer contain active information and are strictly available for historical purposes. Federally qualified health centers fqhc and rural health clinics rhc manual. The provider manuals page is divided into two sections. As a how to manual, the handbook contains, for example, useful material addressing the statutory authority to contract, a description of how fqhc grant money can be used, information on how to obtain new funding, rate setting for the purchase of contracted services, and payment. R173bp 112220 medicare benefit policy manual rhc and. Effective january 1, 20, rhcs and fqhcs can bill for qualified tcm services. Medicare will cover fdg pet imaging for initial treatment strategy for myeloma. Federally qualified health centers fqhc funded under section 330 of the public health service phs act and certified by cms. Federally qualified health center fqhc fqhc s include all organizations receiving grants under section 330 of the public health service act phs.
Medicare and medicaid services cms conditions for coverage for fqhcs. Complete the cms 1500 claim form according to mainecare requirements, along with the following. State of new jersey department of human services division of. You usually pay 20% of the charges for the medicareapproved amount.
State survey agency contacts medicareproviderenrollment. To become certified, fqhcs selfattest to their compliance with medicare conditions for coverage under. Fqhcs billing under pps, coinsurance is 20% of lesser of fqhcs charge for specific payment code or pps rate. Transitional care management services fact sheet, cms medicare learning network, january 2019 resources are also available through the american academy of family practices family practice management, mayjune 20 issue, transitional care management services. The following chapters of the bms provider manual will be updated on an ongoing basis to reflect. Fqhc behavioral health services provider manual change control record 8 of 14 date section pages change o updated to reflect medicaid bulletin dated december 3, 20 discontinuation of edit correction form o updated to reflect medicaid bulletin dated november 30, 20 transition to the cms1500 health insurance claim forms. Qualified health center fqhc behavioral health services provider manual. Evaluation of cmss federally qualified health center fqhc. Archived federally qualified health centers fqhc fee schedules. The manual is regularly updated to reflect the most recent policy and procedure changes. Updates are generally available the month following the effective date of the change.
Health center program compliance manual bureau of primary. Cms 1500 specialty billing manual 120 show cms 1500 specialty billing manual includes. This web site is not updated for increases or decreases in rates due to revisions to cost data. The term locum tenens, which has historically been used in the cms internet only manual to mean feefortime compensation arrangements, is being discontinued because the title of section 16006 of the 21st century cures act uses locum tenens arrangements to refer to both feefortime compensation arrangement compensation arrangements and reciprocal billing arrangements. Medicaid payment policy for federally qualified health centers.
Program of allinclusive care for the elderly pace community behavioral health services program. Basic rural health clinic billing health resources and. Our discussion and proposals in the fqhc pps proposed rule were not intended to change the general requirements with respect to waiving coinsurance for. Provider billing communication behavioral health providers wellcare of georgia will pay clean claims submitted to the health plan within six months of the provided service or discharge from an inpatient facility, unless otherwise required by laws or the medicaid program. Medicare fqhc pps ssa 1834o2 established the fqhc pps for cost reporting periods beginning october 1, 2014. Help planrelated updates and others 08252015 rhc manual. Fqhc s qualify for enhanced reimbursement from medicare and medicaid, as well as other benefits. Per visit pps rates by clinic 10012019 09302020 rich text version. Providers should refer to specific program m anuals for complete information. Perm audit reminder cms requires ahcccs to report all feeforservice claims from october 1, 20 through december 31, 20.
In the december 20 newsletter, dmahs defined telepsychiatry as a. Yes, a fqhc may and bill employ nj familycare for services provided by any of the. Any other requirements for licensing under the state law which are necessary for providing fqhc or rhc services, in accordance with chapter 59 g6. For a onestop resource web page focused on the informational needs and interests of medicare feeforservice ffs federally qualified health centers, go to fqhc center. Billing for services may be intimidating, initially, because there are specific payer requirements for claims submission. The book is not all inclusive of program benefits and limitations. Department of health and human services centers for medicare. The medicare manual pub 1001, medicare general information, eligibility, and.
Department of health and human services centers for. Federally qualified health center fqhc behavioral health. Chapter 522 federally qualified health center and rural health clinic services revised 1212015 disclaimer. Find provider informationincluding forms, program updates, and fee scheduleson this page. Medicare benefit policy manual centers for medicare and. Federally qualified health centers fqhc center cms. The federally qualified health centers fqhcs and rural health clinics rhcs listed below are community health centers chcs that participate with ahcccs. The cms1500 forms are available from the government printing office, the american medical association or major medical oriented printing firms. Federally qualified health center fqhc services medicare. Billing for services after medicare and medicare c plans. Cheat sheet on cms medicare payments for behavioral. Medicare part b medical insurance covers a broad range of outpatient primary care and preventive services. Federally qualified health center mln booklet page 2 of 11 icn mn september.
Medicare benefit policy manual rhc and fqhc update chapter. Managed care organization benefits by nonmco providers. The example in this section assists providers in california childrenas services ccs program billing on the cms1500 claim form. The billing process for federally qualified health centers fqhc and community health centers chc is unique and complex. The codes described below are for federally qualified health centers or rural health clinics and are billed under the. Claims for services should be submitted using the cms 1500 and will be. Ahcccs federally qualified healthcare centers and rural health clinics. Billing manuals colorado department of health care policy. Chapter rural health clinic rhc and federally qualified health center fqhc services pdf see mm11019 pdf fqhc preventive services pdf information on preventive services in fqhcs including hcpcs coding, same day billing, and waivers of coinsurance. If it is furnished on the same day as another visit, only one visit can be billed.
Independent fqhcs bill on cms 1500 claim form to part b. Effective january 1, 20, rhcs and fqhcs can bill for qualified tcm services furnished by a rhc or fqhc practitioner. Health allowable medicaid billing codes table attachment a when billing nj familycare. It also explains how rhcs should bill for certain preventive services. Billing manuals colorado department of health care. Section 2 cms1500 claim filing instructions january 20 2. Health first colorado fqhcrhc billing manual revised. Coding and billing guidelines for psychiatry and psychology services psych014 l30489. Billing secondary and tertiary claim after traditional insurance plans. Then, add additional government regulations, requirements, and rules and you have a billing nightmare identified as a federally qualified health. The explanations on the following page emphasize billing issues common to all ccs providers a proper use of service authorization request sar numbers, npi numbers and c.
Federally qualified health centers fqhcs, fqhc looka. Medicare rural health clinic information 20 iowa department of. Compliance manual does not constitute an exhaustive listing of all requirements that may be included in terms and conditions stated in nofos, noas, and other applicable laws, regulations. Community health centers face a number of billing challenges such as accepting minimum payments, sliding fee schedules, county programs and payment plans. This table, last updated, 201january 108, lists the specific bh billing.
Final second annual report, santa monica, calif rand corporation, rr8861cms, 2015. Fqhc and rhc manual montana medicaid provider website. Submission of expenditure claims to cms to obtain ffp. Federallyqualified health centers fqhc billing guide. Fqhcs billing under air, coinsurance is 20% of charges for fqhc services. An amount not to exceed the providers usual and customary charges to the general public. Rural health clinics rhcs and federally qualified health. The purpose of the compliance manual is to provide a consolidated resource to assist health centers in understanding and demonstrating compliance with health center program requirements. Show the providers billing npi in box 33a and rendering npi in box 32a on all cms1500 claims.
Hrsa announced the availability of the draft health center program compliance manual for public comment in august 2016. Tcm services must be furnished within 30 days of the date of. Federally qualified health center fqhc fqhc is a designation by the federal government. Beneficiary eligibility for cbas provided by an fqhc or rhc shall be determined in the same manner as in the. When billing cpt and hcpcs codes, the fqhcrhc should bill the appropriate. Transitional care management care management medicare.
Most will want these services billed on a ub04, and nonqualifying visits on a cms1500 form. Since you are billing incidentsince you are billing incidenttoservices withservices with the professional component to medicare part a as an rhc you cannot bill the samea as an rhc you cannot bill the same incidenttoservices to medicare part b to receive a second payment. Then, add additional government regulations, requirements, and rules and you have a billing nightmare identified as a federally qualified health center fqhc or rural health clinic rhc. Individuals and groups submitted more than 700 comments. Beneficiary coinsurance cms iom, publication 2, medicare benefit policy manual, chapter, section 80. Where an rhc or a fqhc is approved for billing other medical and health services. Feefortime compensation arrangements and reciprocal billing. A federal government website managed and paid for by the u. Noninstitutional providers resources is designed to assist noninstitutional providers with hfs billing and payment for services, as well as provide answers to frequently asked questions and links to webinar slides. Effective for services performed on or after june 11, 20, medicare has ended the ced requirement for fdg pet and petct and petmri for all oncologic indications contained in section 220.
Updated june 2011, march 20, june 20, october 20, march 2015. Medicaid participating fqhc psychologist or psychiatrist on the cms 1500 form or in cms 1500 format. A billing guide for federally qualified health centers fqhc is. Provider types affected this mln matters article is intended for rural health clinics rhcs and federally qualified health centers fqhcs submitting claims to medicare administrative contractors macs for services to. Both current and discontinued manuals have historical versions available. Medical billing manual california department of health. Federally qualified health center centers for medicare. Provides an overview of federally qualified health centers fqhcs and health center program awardees and lookalikes, important safety net providers in rural areas. We implemented the billing requirements for waiving coinsurance in the fqhc setting through program instruction cms pub.
There are 3 types of organizations that are eligible to enroll in medicare as fqhcs. If an acp is rendered on the same day as the awv it is considered a preventive service and must be reported with modifier 33. Oct 01, 2016 federallyqualified health centers fqhc billing guide. If an actual or apparent conflict between this document and an agency rule arises, the agency rules apply. Billing guidelines fqhc submits claim to mco with the following minimum requirements for starstar kids and chip 1. Evaluation of cms fqhc apcp demonstration final first annual report katherine l. Fqhc or rhc shall refer to acs memo m1201 dated january 5, 2012 for. The following definitions apply for purposes of this chapter.
The rendering provider is the supervising psychologist or psychiatrist. Chapter 9 rural health clinics federally qualified health centers. Federally qualified health centers fqhcs and the health. Evaluation of cms fqhc apcp demonstration final first. Each historic provider manual is archived on the scdhhs website during a. Rural health clinics federally qualified health centers pdf chapter 9 crosswalk pdf chapter 10 home health agency billing pdf. Eligible professional manual for federally qualified health centers and rural health centers. Apr 01, 2017 federallyqualified health centers fqhc billing guide.
Medicare payment may not be made to a fqhc for services provided to hospital inpatients and outpatients. Family planning change for billing of transcervical sterilization device. Please visit the fqhc center page for more information on understanding the methodology and payment rates for the new fqhc pps. The mo healthnet professional billing book contains information to help providers submit claims correctly to the mo healthnet program. Chapter 21 medicaid provider manual hawaii medicaid. Mhcp uses the same medicare formula employed on the form cms222 in the medicare provider reimbursement manual as modified for ma covered services, and used to establish pps rates for january 1, 2001. If the fqhc practitioner should provide services to a hospital patient, these services are not covered under the fqhc benefit. Federally qualified health centers fqhcs and rural health. Further billing instructions will be published in the ahcccs ffs provider billing manual in the near future. May a fqhc be reimbursed by nj familycare for services provided by a licensed psychologist. It is necessary to identify the 1999 and 2000 costs used to calculate the pps rate. Medical specialty mental healtprh ovserivded tices o a beneficbyiar a cy ertified provider, the cost of these services is paid by a combination of, state, and federal. Reimbursement is made at 50% of medicaid feeforservice ffs rate. Federally qualified health center fact sheet 1 fact sheet federally qualified health center t.
787 776 833 316 1351 1302 29 1134 815 926 987 664 1346 455 961 370 1011 803 1465 523 17 1297 322 1324 250 1564 399 1071 1084 1229 1158 1242 1244 840 454 1147 743 111 37 312 945 984 387 223 1118 963