Evaluation and Management Billing for FQHCs

This session will discuss reporting Evaluation and Management Services to Medicare as a Federally-Qualified Health Center. We will include a review of the new 2021 Evaluation and Management guidelines and how to apply them to FQHC billing. We will define FQHC providers, locations, and services. It is important that participants come away with a detailed understanding of the difference between “FQHC services” and “Non-FQHC services”, how each are billed, and how to avoid commingling problems. We will explore proper FQHC G-Payment code (G0466, etc.) for established and new patients, office visits, preventive services, multiple encounters, and minor surgical procedures. Incident-to services and venipuncture examples will be reviewed. We will take a look at how the Medicare payment and patient cost-sharing balances are calculated in relation to charge amounts and the FQHC PPS Encounter Rate. We will review several different detailed claim scenarios. Participants will leave with a detailed understanding of billing Evaluation and Management Codes in a FQHC.