Source: http://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.html?redirect=/center/fqhc.asp
Timestamp: 2014-08-27 10:52:55
Document Index: 13171603

Matched Legal Cases: ['§150', '§80', '§181', '§120', '§182', '§140', '§40', '§50', '§70']

> Federally Qualified Health Centers (FQHC) Center Federally Qualified Health Centers (FQHC) Center
FAQs on the new FQHC PPS are now available. Please visit the FQHC PPS Webpage at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Index.html and see FQHC PPS FAQs in the Downloads section.
MLN Connects™ National Provider Call - Review of the New Medicare PPS for Federally Qualified Health Centers
CMS hosted a National Provider Call on Wednesday, May 21, 12:30 – 2:30 p.m. ET, to review the final policies for the new Medicare PPS for FQHCs. The slide presentation is available at http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2014-05-21-FQHC.html. CMS hosted a second National Provider Call on Wednesday, June 25, 1:30 - 3:00 pm ET, to review the operational requirements for the new Medicare PPS for FQHCs. The slide presentation is available at http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2014-06-25-FQHC-NPC.html
On May 2, 2014, CMS published a final rule that establishes methodology and payment rates for a prospective payment system (PPS) for Federally Qualified Health Center (FQHC) services under Medicare Part B beginning on October 1, 2014, in compliance with the statutory requirements of the Affordable Care Act. Medicare will pay FQHCs a single encounter-based rate per beneficiary per day, with some adjustments. Payment will be 80 percent of either the PPS rate of $158.85, or the total charges for services furnished, whichever is less. FQHCs will be able to bill for separate visits when a mental health visit occurs on the same day as a medical visit. The FQHC PPS rate will be adjusted for geographic differences in the cost of services by using an adaptation of the Geographic Practice Cost Indices used to adjust payment under the physician fee schedule. In addition, the rate will be increased by 34 percent to account for greater intensity and resource use when an FQHC furnishes care to a patient that is new to the FQHC or to a beneficiary receiving a comprehensive initial Medicare visit or an annual wellness visit. FQHCs will transition into the PPS beginning October 1, 2014, based on their cost reporting periods.
FQHC Preventive Services
FQHCs are paid an all-inclusive rate (AIR) per visit for qualified primary and preventive health services. Except for IPPE and DSMT/MNT, all preventive services furnished on the same day as another medical visit constitute a single billable visit. If an IPPE or DSMT/MNT visit occurs on the same day as another billable visit, two visits may be billed. All of the preventive services listed below may be billed as a stand-alone visit if no other service is furnished on the same day. Additional information on payment and claims processing for FQHC preventive services is available in the Medicare Claims Processing Manual, Pub 100-04, Chapters 9 and 18. Additional information on FQHC policy for preventive services is available in the Medicare Benefit Policy Manual, Pub 100-02, Chapter 13. These manuals are available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c09.pdf, http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c18.pdf, http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf. The chart below lists preventive services that are eligible to be paid based on the FQHC’s AIR when billed without another covered visit.
Paid at the AIR
Eligible for Same Day Billing
Initial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of Medicare enrollment
Ch 9 §150
Ch 18 §80
Ch 9 §181
Ch 18 §120
Ch 9 §182
Annual wellness visit, including PPPS, first visit
Ch 18 §140
Annual wellness visit, including PPPS, subsequent visit
Ch 18 §40
Ch 18 §50
Ch 18 §70
Note: Separate instructions will be available for FQHCs billing under the PPS on or after October 1, 2014. Sample Billing for Preventive Services
Eligible preventive services (identified above) shall be paid based on a FQHC’s AIR when submitted as shown in the following example on a 77X TOB with revenue code 052X:
44 HCPCS/RATES
E&M code, 99XXX
Special Open Door Forum
On November 4, 2013, CMS held a Special Open Door Forum on Proposed Rule CMS-1443-P: Medicare Prospective Payment System for Federally Qualified Health Centers The transcript and audio files are posted in the Downloads section of CMS's Special Open Door Forum webpage at: http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODFSpecialODF.html
On September 18, CMS issued a proposed rule that would establish methodology and payment rates for a prospective payment system (PPS) for Federally Qualified Health Center (FQHC) services under Medicare Part B beginning on October 1, 2014, in compliance with the statutory requirements of the Affordable Care Act. CMS is proposing payment to FQHCs based on a single encounter-based per diem rate per Medicare beneficiary. The encounter-based per-diem rate would be calculated based on an average cost per encounter and is estimated to be $155.90, subject to change in the final rule based on more current data. The rate would be adjusted for geographic differences in the cost of services by adopting the Geographic Practice Cost Indices (GPCI) used to adjust payment under the physician fee schedule (PFS). In addition, the rate would be adjusted (increased by approximately 33 percent) for greater intensity and resource use when an FQHC furnishes care to a patient that is new to the FQHC or to a beneficiary receiving a comprehensive initial Medicare visit (i.e., an initial preventive physical examination or an initial annual wellness visit). FQHCs would transition into the PPS beginning October 1, 2014, based on their cost reporting periods.
This proposed rule also amends the Clinical Laboratory Improvement Amendments (CLIA) of 1988 to be in alignment with the Taking Essential Steps for Testing (TEST) Act of 2012, proposing the regulatory changes needed to fully implement the TEST Act. This proposed rule outlines the framework for the application of sanctions in proficiency testing (PT) referral cases.
The proposed rule will be published in the September 23 Federal Register. CMS will accept comments on the proposed rule until November 18, 2013, and will respond to them in a final rule to be issued in 2014.
Additional information is available in the CMS press release , fact sheet and proposed rule. Vaccination is the Best Protection Against the Flu [PDF, 414KB]
SE1039 – Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
Important Links Billing / Payment	Electronic Billing & EDI Transactions
Policies/Regulations	Quarterly Provider Updates
Enrollment/ Participation/ Certification	Medicare Provider-Supplier Enrollment
Medicare Secondary Payer	Internet-Only Manuals (IOMs)
Education	MLN General Information
Helpful Links	Rural Health Clinics Center
Rural Assistance Center (for FQHC) - Opens in a new window
Change Request 8743: Implementation of a Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs)
Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers [PDF, 215KB]
Medicare Benefit Policy Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 230KB]
: Payment for Services: State Plan Amendments (pages 6-51)
Provider Reimbursement Manual: Chapter 29-(T11) -- Independent Rural Health Clinic and Freestanding Federally Qualified Health Center cost Report Form CMS 222-92 (Instructions) [ZIP, 344KB]
New, Deleted, and Revised ICD-10 Codes - Summary Tables
Coverage	Medicare Coverage - General Information
Medical Review/ Fraud & Abuse	Beneficiary Complaint Response Program
Resources	Critical Access Hospitals Center
Medicare Fee-for-Service Part B Drugs	Competitive Acquisition for Part B Drugs & Biologicals
Publications	MLN Products
- Search for "Federally Qualified Health Center" Contacts	CMS Regional Offices
CMS Regional Office Rural Health Coordinators Updated July 2013 [PDF, 17KB]