(Medicare Claims Processing Manual)

When billing these services on FQHC PPS claims, a FQHC payment code and qualifying visit HCPCS code is not  required.  100 - Frequency of Billing and Same Day Billing  (Rev. 3434, Issued: 12- 31-15, Effective: 03-31-16, Implementation: 03-31-16)  RHC and FQHC claims cannot overlap calendar years.  Therefore, the statement dates, or from and through dates of the claim, must always be in the same calendar year.   RHCs and FQHCs billing under the FQHC PPS may submit claims that span multiple days of service.  FQHCs billing under the PPS must submit all services that are rendered on the same day on one claim.  General information on basic Medicare claims processing can be found in this manual in:  Chapter 1, General Billing Requirements, (http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf) for general claims processing information;   Chapter 2, Admission and Registration Requirements, (http://www.cms.hhs.gov/manuals/downloads/clm104c02.pdf) for general filing requirements applicable to all providers.  For Medicare institutional claims:   See the Medicare Claims Processing Manual on the CMS website for general Medicare institutional claims processing requirements, such as for timely filing and payment, admission processing, and Medicare Summary Notices.   Contact your MAC for basic training and orientation material if needed.  Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12070CP   06/07/2023 Internet Only M anual Update to Publication 100-04, Chapters 9 and 18 to Clarify Vaccine Payment Instructions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)  07/10/2023 13218 R11200CP 01/12/2022 Implementation of the GV Modifier for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for Billing Hospice Attendin g Physician Services  01/03/2022    12357 R11095CP  10/29/2021 Implementation of the GV Modifier for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for Billing Hospice Attending Physician Services  - Rescinded and replaced by Transmittal 11200 01/03/2022 12357 R11029CP 09/29/2021 Implementation of the GV Modifier for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for Billing Hospice Attending Physician Services  - Rescinded and replaced by Transmittal 11095 01/03/2022 12357 R10907CP 08/10/2021 Implementation of the GV Modifier for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for Billing Hospice Attending Physician Services  - Rescinded and replaced by Transmittal 11029 01/03/2022 12357 R10357CP 09/18/2020 Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 9, Section 70.7 and 70.8. 10/19/2020 11961 R3434CP 12/31/2015 Reorganization of Chapter 9 03/31/2016 9397 R3000CP  07/25/2014 Update to Pub. 100-04, Chapter 09 to Provide Language-Only Changes for Updating ASC X12 08/25/2014 8670 R2186CP  03/28/2011 Waiver of Coinsurance and Deductible for Preventive Services in Rural Health Clinics (RHCs), Section 4104 of Affordable Care Act (ACA)  04/04/2011 7208 R2122CP 12/21/2010 Waiver of Coinsurance and Deductible for Preventive Services in Rural Health Clinics (RHCs), Section 4104 of Affordable Care Act (ACA)  Rescinded and replaced by Transmittal 2186 04/04/2011 7208 R2093CP 11/12/2010 Waiver of Coinsurance and  Deductible for Preventive Services in Rural Health Clinics (RHCs), Section 4104 of Affordable Care Act (ACA)  Rescinded and replaced by Transmittal 2122 04/04/2011 7208 R2034CP 08/24/2010 Affordable Care Act (ACA) Mandated Collection of Federally Qualified Health Center (FQHC) Data and Updates to Preventive Services Provided by FQHCs 01/03/2011 7038 R2013CP 07/30/2010 Affordable Care Act (ACA) Mandated Collection of Federally Qualified Health Center (FQHC) Data and Updates to Preventive Services Provided by FQHCs - Rescinded and replaced by Transmittal 2034 01/03/2011 7038 R1843CP 10/30/2009 Outpatient Mental Health Treatment Limitation  01/04/2010 6686 R1719CP 04/24/2009 Rural Health Clinic  (RHC) and Federally Qualified Health Clinic (FQHC) Updates  10/05/2009 6445 R1707CP 03/27/2009 Assignment of Initial Enrollment FQHCS, ESRD Facilit ies, and RHCs 04/27/2009 6207 R1472CP 03/06/2008 Update of Institutional Claims References  04/07/2008 5893 R1426CP 02/01/2008 Announcement of Medicare Rural Health Clinics (RHCs) and Federally 02/12/2008 5896 Qualified Health Centers (FQHCs) Payment Rate Increases  R1421CP  01/25/2008 Update of Institutional Claims References - Rescinded and Replaced by Transmittal 1472 04/07/2008 5893 R1255CP 05/25/2007 Guidelines for Payment of Diabetes Self-Management Training DSMT) 07/02/2007 5433 R1158CP 01/19/2007 Guidelines for Payment of Diabetes Self-Management Training DSMT)  Replaced by Transmittal 1255 07/02/2007 5433 R820CP 02/01/2006 Sites of Service Revenue Codes for Rural Health Clinics and Federally Qualified Health Centers  07/03/2006 4210 R794CP 12/29/2005 Announcement of Medicare Supplemental Payments to Federally Qualified Health Centers Under Contract with Medicare Advantage Plan  04/03/2006 3886 R773CP 12/02/2005 Announcement of the Medicare Federally Qualified Health Center Supplemental Payment 04/03/2006 3886 R771CP 12/02/2005 Revisions to Pub. 100- 04, Medicare Claims in Preparation for the National Provider Identifier (NPI)  01/03/2006 4181 R371CP 11/19/2004 Updated Billing Instructions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)  04/04/2005 3487 R167CP 04/30/2004 Discontinued Use of Revenue Code 0910 10/04/2004 3194 R001CP 10/01/2003 Initial Publication of Manual NA NA Back to top of Chapter