According to Section 330 of the Public Health Service Act (PHS), Federally Qualified Health Centers are organizations that qualify to receive grants under the aforementioned section. Federally Qualified Health Centers (FQHCs) qualify to receive enhanced reimbursements from Medicaid and Medicare alongside other benefits.
The core focus of FQHCs is to provide health medical services to underserved populations or areas, the offer of a sliding fee scale, provision of comprehensive service, possession of an ongoing quality assurance program, and having a governing board of directors. Some “FQHC look-alikes” and some tribal organizations may also receive special Medicaid and Medicare reimbursement.
Purpose & Focus of FQHCs
Generally, the main purpose of FQHCs is the service to local or underserved communities. Among the key requirements to qualify as a Federally Qualified Health Center, the health center must accept all patients who seek its service without regard to the patient’s ability to pay.
These health centers ought to be able to provide primary care services for all age groups. They also ought to provide preventive health services on site, or by a special arrangement with another provider. A health center can also provide the following services either directly or through another provider: dental services, hospital and specialty care; transportation services necessary for sufficient patient care; and mental health and substance abuse services.
These healthcare organizations serve special populations such as the homeless, migrants and residents of public housing. Migrant health centers offer comprehensive and culturally-tailored primary health services to immigrants and seasonal workers and their families. The healthcare for the homeless program is focused on patients who reside on the streets, or in shelters or temporary housing.
The public housing primary care health centers, on the other hand, provides residents of public housing with access to comprehensive primary medical care services. Most of the time, these services are offered on the public houses or within easy access to residents of public housing.
Billing & Financial Struggles of FQHCs
To assert the primary purpose of FQHCs, the health center grantees and Look-Alikes have a sliding fee scale for medical billing. FQHCs are not permitted to charge more than a nominal fee for persons whose income is below the Federal Poverty Level. Persons with incomes that are between 101% and 200% Federal Poverty Level are to be charged using a sliding fee scale. The fee discounts offered here will depend on the patient family size and income.
However, a host of challenges plague FQHCs, especially when it comes to FQHC billing and coding. They cater to close to 21 million individuals annually, patients that need care most. And FQHCs do something that other highly funded medical groups do not do: they worry little about revenue and focus on the patients and providers’ quality of care.
Despite the fact that Medicare increased payments to FQHCS to the tune of 32 percent in the Affordable Care Act, the FQHCs are still plighted with low funds for operational necessities. Moreover, Medicare and Medicaid plans are growing in popularity, consequently, states are enrolling more members, thus, overwhelming the capacity of FQHCs.
To make it worse, the ACA funding expires after five years. As a result, many of these health centers recruit the help of FQHC billing and coding companies to help them optimize and streamline their medical billing efforts.
Since FQHCs are dependent on preferential Medicaid and Medicare reimbursement, just few centers could possibly survive on the regular reimbursement system. To learn more about FQHCs, visit www.hrsa.gov.Read More