Maximizing FQHC Revenue Cycle Outcomes

 In Blog

At MMG, we know that our FQHC clients see opportunities and face challenges that are unique to their structure and designation.  In our work with clients like you, we have identified a number of ways in which FQHC’s are improving revenue cycle performance and successfully navigating the Medicare reimbursement arena.  In this article, we are pleased to share four ways you can do the same.

  1. Conducting Fee Schedule Review and Analysis

A fee schedule review is vital to ensure that all revenue opportunities are fully realized and that you remain in compliance with FQHC regulation.  A fee schedule analysis should include fee recommendations based on market reimbursements and current payor fee schedules. G code fees should be compared to the current Medicare GAF reimbursement to ensure appropriateness. A review of the previous year’s Medicare cost report should be included to ensure that a proposed fee is in line with the actual costs of the FQHC. Once completed, the fee schedule should be evaluated against local market competition to ensure fees reflect the market in which the FQHC operates.

  1. COVID Vaccine Reimbursements

All Covid vaccine administration codes should be reported on your cost report – not on a claim.  This includes all Medicare advantage plans. All Medicaid and commercial payers will be billed to the specific plan for reimbursement. The vaccine requires a specific code for each injection, 1st or 2nd, and there is a specific code for the brand name of the vaccine: Pfizer, Moderna or Johnson & Johnson. A specific and separate code is also required for the administration of each brand.

  1. Current CPT Codes

Medicare annually deletes and adds CPT codes. It is important to stay up to date with deleted codes in order to reduce denied/rejected claims. Newly added codes may offer an opportunity to increase revenues for services not previously covered by Medicare.

  1. Measuring Quality Outcomes

Quality measures are an important aspect of maximizing revenue with Medicare. It is critical to maintain up-to-date quality measures and work with the EMR vendor to ensure they are properly tracked and reportable. On-time submission of quality data will avoid penalties and provide possible increased revenue.

If you have any questions or would like assistance with any of the topics mentioned above, contact Penn Kurtz (pkurtz@medicmgmt.com)  Renee Genet (RGenet@medicmgmt.com) or Robert Hague (RHague@medicmgmt.com).

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