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Utopia Medical Billing FQHC Billing Services

Utopia Medical Billing understands the complexities of billing for safety-net providers, including managing diverse patient populations, handling complex billing codes, and ensuring compliance with federal and state regulations. Our FQHC billing services ensure accurate claims, reduce denials, and can boost your revenue by up to 30%. Let us handle the billing challenges so you can focus on providing essential care to your community.

Why Should You Outsource FQHC Billing?

Federally Qualified Health Centers (FQHCs) provide a wide range of services and employ a variety of medical professionals, which makes medical billing 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 medical billing and revenue cycle management (RCM).

Our system has been perfected through a decade of application, and we are now able to guarantee that our services will increase our clients’ revenue. We “scrub” claims for errors prior to submission, submit according to each payer or clearinghouse’s requirements, and then track each claim until it is paid. We follow up on denials at no additional cost, and never just ignore a difficult claim. Utopia Medical Billing provides billing services that maximize your center’s income and streamline the entire revenue cycle.

Experienced and HIPAA Compliant

Because FQHCs offer so many different kinds of services, it is difficult for medical staff to be aware of all the current correct codes – and Medicare codes can be very complicated. Utopia Medical Billing provides coders and billers who are not only certified but also have experience providing FQHC billing services. Every employee is also trained on HIPAA best practices to ensure that patient information is handled securely and your organization remains compliant.

The Challenges of Medical Billing for FQHCs

FQHCs have many patients with a wide variety of needs, which means coders and billers must be experienced with many different codes. The following are just a few of the reasons billing for this kind of medical facility can be so complex:

Per-Diem Payments

If a patient has more than one visit with an FQHC practitioner on the same day, they must be billed as one visit, except for a qualified mental health visit and a medical visit on the same day or if the second visit requires a separate diagnosis, such as being seen once for an illness and returning later that day with an injury. Billers must be attentive to what each visit was for and ensure that separate bills are not submitted if neither exception applies. Our billers at Utopia Medical Billing receive ongoing training to stay up-to-date with the unique requirements of each specialty or organization they serve.

Off-Site Visits

Qualified FQHC visits can occur not only at approved facilities but also at a patient’s residence, a Skilled Nursing Facility (if covered by Medicare Part A), or even the scene of an accident. The coding for these situations must carefully document the medical necessity and location. Utopia Medical Billing’s medical billing software and training system ensure our billers are updated on these specific requirements, including variations from state to state.

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.

 

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