- Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates
- Outpatient Services for Registered Inpatients
- Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing for Drug Wastage: JW and JZ Modifier
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Billing Medicare Part A When VA-Eligible Medicare Beneficiaries Receive Services in Non VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Electronically Submitted Claims that Exceed $99,999.99
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
- Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims
Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
Medicare will provide supplemental payments to FQHCs that contract with MAOs to cover the difference, between the payment received from the MAO and the payment to which the FQHC would be entitled under FQHC PPS.
An FQHC is only eligible to receive this supplemental payment when FQHC services are provided during a face-to-face encounter. FQHC’s seeking supplemental payments must submit copies of their contracts under each MA plan.
New Billing Instructions for FQHC PPS Providers
- Payment code with facility’s payment code charge to represent the billable encounter
- Qualifying visit HCPCS code must be reported with actual line-item charges for services provided
- All services must be billed with revenue code 0519 with one (1) unit (including any incident to services)
- MAO plan interim supplemental rate is no longer reflected on claim line
- All other billing guidelines apply
Claim Example: MAO Plan Supplemental Payment Claim for Established FQHC Patient
Established MAO patient comes to the FQHC for a medical encounter. Claim will be reported as follows:
- Payment code G0467 (medical encounter for established FQHC patient) with one (1) unit, Total Charges reflecting the facility’s payment code charge for G0467 ($150)
- Qualifying visit HCPCS code with one (1) unit, Total Charges reflecting actual line-item costs for service ($120)
- All lines report revenue code 0519
- 0001 Totals line calculated appropriately
| 42 Rev Cd | 43 Description | 44 HCPCS | 45 Serv Date | 46 Serv Units | 47 Total Charges |
|---|---|---|---|---|---|
| 0519 | FQHC visit, estab pt | G0467 | 100114 | 1 | $150 |
| 0519 | Office/outpatient visit estab pt | 99212 | 100114 | 1 | $120 |
| 0001 | Total | $270 |
Payment will be the difference between the MAO plan’s contracted payment rate and what the reimbursement would be under FQHC PPS (the lesser of the adjusted PPS rate and the facility’s payment code charge for the reported payment code).