Federally Qualified Health Centers serve underserved patients with greater responsibility. This unique medical specialty requires greater attention to collect reimbursements and an all-inclusive model to streamline the payment system. Docto Bill focuses on the harmony of revenue cycle management and abides by the requirements that are essential to keep your business running smoothly.

FQHC Billing Services Provided by Docto Bill

Federally Qualified Health Centers (FQHCs) provide a wide range of services and employ a variety of medical professionals, which means medical billing can be especially complex. Coding must be done exactly as specified by the Centers for Medicare & Medicaid Services (CMS) special rules for facilities designated as FQHCs, so it has proven beneficial to outsource coding and billing to professionals who specialize in revenue cycle management (RCM).

We are trained on HIPPA best practices

Docto Bill codes can be very complicated, and because FQHCs offer so many different kinds of services, it is difficult for medical staff to be aware of all the correct codes. Docto Bill provides coders and billers who are not only certified, but also have experience providing FQHC billing services. Every employee is also trained on HIPPA best practices to ensure that patient information is handled securely.

The Challenges of Medical Billing for FQHCs

Complications start with scheduling:

The medical billing for cardiology process starts in the scheduling phase when insurance coverage and payer requirements have to be confirmed. Even details such as whether the appointment happened in an in-patient, out-patient or emergency room/urgent care setting must be correctly coded or the claim will be denied.

Off-site visits

Qualified FQHC visits not only take place at approved facilities, but may be at the patient’s residence, a Skilled Nursing Facility (if covered by Medicare Part A) or even the scene of an accident. The coding for any of these situations must carefully document the medical necessity and location.

Mental health and substance abuse coverage

In addition to medical visits, FQHCs may also provide behavioral health care management and psychiatric consultation. Medical coders and billers must be familiar with these additional specializations and the CMS expectations for each type of visit.

Our software assures coders have the correct codes

Our innovative approach to medical billing starts with our proprietary software that assures coders have the correct codes including all the latest updates. It picks up the billing cycle when the patient first makes an appointment and streamlines the entire process until the claim has been paid.

We will submit claims and manage any rejections

In addition to having an expert staff of medical billers to scrub and submit claims, then manage any rejections or denials, we also offer payer credentialing, compliance reviews, and annual payer adjustments and pay back.