We provide insights and tips on FQHC billing for behavioral health and SUD services to help ensure accurate and efficient reimbursement.

1. FQHC Billing For Behavioural Health And
SUD Services
FQHC medical billing is similar to outpatient private practice billing, but certain
restrictions apply to ensure the facility remains compliant. FQHCs must collect
Medicare coinsurance, provide after-hours access for patients, and offer services on
a sliding scale. As reimbursement is based on bundled services, it is critical for
FQHCs to adhere to the strict guidelines established by the Centers for Medicare
and Medicaid (CMS) to avoid denied claims.
Furthermore, the entire billing process, from patient registration to collecting unpaid
patient balances, requires constant attention to keep the facility from losing revenue
or the ability to treat its patients. Let’s have a look at the guidelines related to FQHC
billing for behavioral health and SUD services:
FQHC Billing Guidelines for for
Behavioural Health and SUD
Services

2. Medical billing for FQHCs is more complex than billing for standard private practices.
The billing and coding guidelines for a FQHC are strict if not set in stone. FQHC
claims submitted to CMS with billing and coding errors, such as incorrect CPT and
HCPCS codes, will be denied. These guidelines are in place to ensure that coders
thoroughly review documentation and use current ICD-10 codes. Billers must also
consider which services can be billed.
For FQHCs, the below-mentioned simple but critical guidelines must be
followed:
 Only designated healthcare professionals may provide services to patients in an
FQHC, which must be done in person in an outpatient setting. Encounters are
permitted in a skilled nursing facility (SNF) where Medicare Part A applies.
 Mental health providers or social workers may consult with family members, but they
may only bill for services provided to the patient.
 FQHCs bill for preventive services such as annual wellness visits (AWV), physicals,
and screenings. Additional services are billable, such as screening
electrocardiograms, end-of-life planning, and test-result follow-up counseling.
CMS also specifies specific codes for encounters, such as the amount of time spent
with the patient, the amount of time spent counselling, whether two billable
encounters were completed on the same day, or whether the patient received
advanced care planning (ACP) or chronic care management.
Understanding the high level of specificity of billing and coding necessitates the
attention of an expert who is constantly up to date on the latest changes with ICD-10
and HCPCS codes, as well as CMS billing regulations.
FQHC Coding Guidelines
FQHC coding differs from typical outpatient or hospital clinic coding in that it requires
a higher level of specificity that corresponds with the PPS. The following are specific
codes for patient encounters in a FQHC:
 G0466 – new patient.
 G0467 – established patient
 G0468 – initial preventive physical exam (IPPE) or an annual wellness visit (AWV).
 G0469 – mental health, new patient
 G0470 – established patient, mental health
This is only a partial list of encounter codes; claims must include specific FQHC
revenue codes and the appropriate HCPCS code. Timing for special visits, such as
Advanced Care Planning (ACP), necessitates using unique CPT codes and
modifiers to indicate the amount of time spent with a patient. Furthermore, “incident
to” billing from an FQHC with appropriate coding for services rendered by a non-
physician provider, such as a nurse practitioner or physician assistant, is permitted.
To avoid reimbursement delays, all claims submitted by an FQHC must be accurate
down to the modifier, from preventive medicine to telemedicine.

3. Tips for Correct FQHC Billing for
Behavioural Health and SUD
Services
FQHC medical billing and coding can be complicated, but you don’t want denials
or collection issues to make that complexity impossible. Claim denials and a low
collection rate can quickly spell disaster for an FQHC’s revenue cycle, but following
these tips can provide you with peace of mind and a path to improving both your
denial and collection rates.
 Concentrate on capturing accurate eligibility information to ensure that your staff is
proficient in gathering correct demographic and insurance information on every
patient and that all benefits are verified before rendering services.
 Change to automated tools and use electronic health records and billing systems to
increase centre efficiency.
 Engage patients in open, informative conversations about financial responsibility and
encourage them to use their patient portal to inquire about bills.
 Concentrate on your processes; ensure that as much of your process as possible is
automated to save time and reduce errors when gathering patient information for
checking eligibility, registration, and coding for an office visit.
 Ensure that your coders and billers are always up to date to be aware of compliance
changes and regulatory updates from CMS to avoid potential claim denials.
Stay up-to-date with 24/7 Medical Billing Services!
FQHC billing and coding regulations are constantly changing. CMS employs the
prospective payment system (PPS) to provide a more controlled reimbursement rate
for rendered services. Still, the PPS rates are updated annually to meet market
variations. FQHC billing experts understand the significance of these changes and
how they can affect coding and claim submission accuracy. That’s why contacting
the 24/7 Medical Billing Services experts is recommended to stay up-to-date and
ensure correct FQHC billing and coding to enhance reimbursements for behavioral
health and SUD services.
Even the CMS website has an entire page dedicated to FQHCs medical billing and
payment information ranging from the pandemic to telehealth. Overall, these
changes can significantly impact a FQHC’s revenue cycle management outcomes.
About 24/7 Medical Billing Services:
24/7 Medical Billing Services is the nation’s leading medical billing service
provider catering services to more than 43 specialties across the entire 50 states.
You can rely on us for end-to-end revenue cycle management. We guarantee up to
10-20% increase in the revenue with cost reduction of your practice for up to 50%.

4. Call us today at 888-502-0537 to know more on how we can help boost profitability
for your practice.
Media Contact –
24/7 Medical Billing Services,
28405 Osborn Road,
Cleveland, OH, 44140
Tel: + 1 -888-502-0537
Email: info@247medicalbillingservices.com
Website: https://www.247medicalbillingservices.com/