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What are Federally Qualified Centers (FQHCs)?

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 what are 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

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5 Best Practices of OB/GYN Billing & Coding

OB/GYN billing is a highly confusing and complicated forms of medical billing. Usually, OB/GYN billers undergo a tough medical billing process when the patient switches to another physician during the pregnancy. The multiple complications or complaints associated with pregnant women and postpartum conditions make the complete process quite challenging.

Here are 5 best practices of OB/GYN billing and coding to ensure increased revenues and guaranteed reimbursements. medical billing software

1. Maintaining Electronic Health Records

By storing the complete information about the health of the patients in digital format, preferably online, you can make accessing the data easier, simplify patient care and enhance patient engagement. Efficient EHR software offered from a reliable medical billing software company can prove to be a huge help in creating a meaningful and accessible pool of data that enhances the productivity and care. Opting for a totally web-based EHR solution is a great choice, ensuring an easy availability of the records when needed.

2. Implementing Credentialing Protocols

Giving proper credentialing is an essential aspect of getting the right reimbursement of money. It lets you stay in touch with the progress of the submissions and view the details for everything all in one place. There are several OB/GYN billing consultants that allow the clients to get an individual and personal analysis according to their mode of operation. Usually, recommendations are offered for them to improve the business in all aspects, thereby making them even more precise and efficient.

3. Collecting Co-Payments at the Time of Service

Prior to the patient visiting the doctor, the staff needs communicate with patients and audit their information at the time of registration. Collect the co-pay then, abstain from re-touching the documents of the patient, and try for a quick departure. This brings higher collections and it is advised to figure out how to redesign staff and strategies to get it going. Work towards collecting about 95% of co-pays in advance; real collections are generally more like 90%. You can request staff to keep an outline that shows when they don’t collect, along with the reasons.

4. Staying Updated with New Processes

Stay informed about the new updates introduced by the American Medical Association to guarantee that they can expand reimbursement and the claims will be pointlessly denied. AMA has introduced 335 amendments to the Terminology last year, including a few code increments. Changes have been made into the codes for vaginal and laparoscopic-assisted hysterectomy, analysis of chromosomes, genomic sequencing, human papillomavirus risks, human papillomavirus types, vaccination codes and several others. The coding changes may be influencing the payments.

5. Verifying the Patient’s Insurances

It’s very important to verify the insurance of the patients. Call payers to verify coverage or you can opt for online confirmation. If you can’t check the insurance status for every patient, try to confirm it for patients getting services that are priced more than your service, for example, attendant visits, vaccinations, or lab tests. On the off chance that you discover that the patient is not covered, get in touch with him or her prior to the appointment date and give let them choose whether to make the visit and pay for it themselves or get back to make another appointment when things have been rectified.

Do you have any exceptional OB/GYN billing and coding tips to share? Let us know in the comments below.

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