- 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
- Annual Wellness Visits ‑ Billing Tips for Physicians
- 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
FQHC and Group Therapy Services Job Aid
Historically, federally qualified health center’s (FQHC’s) billing instructions have been the same. However, effective 1/1/2011, the billing requirements changed for this facility type. Beginning with dates of service on or after 1/1/2011, when billing Medicare, FQHCs must report services provided during the encounter/visit by listing the appropriate HCPCS code. The additional revenue lines with detailed HCPCS code(s) are for information and data gathering purposes in order to develop the FQHC Prospective Payment System (PPS). The additional data will not be utilized to determine current Medicare payments to FQHCs. The Medicare claims processing system will continue to make interim payments under the current FQHC interim per-visit payment rate methodology with final payments determined within the Medicare cost report.
Billing
It has been brought to National Government Services’ attention that FQHCs are submitting group therapy codes with a revenue code in the 52X series. Group therapy is not a payable benefit for FQHCs. The changes effective 1/1/2011, did not change the policy.
Currently, National Government Services rejects claims submitted with revenue code 0900 and group therapy codes. National Government Services will reject claims submitted with revenue 0521 or any code from the 52X series, when a group therapy code is submitted. Since these services are considered at cost report time, FQHCs are being instructed not to submit them on their claims for payment. The reason code applicable to this type of billing error is 7C935.
Only therapy between a patient and a physician, clinical psychologist or clinical social worker is billed to National Government Services. However, group therapy is covered and reimbursed through the Medicare cost report.
Related Content
The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 9, (215 KB) for billing information as it specifically relates to FQHCs. The UB-04 Specification Manual provides definitions of UB-04 fields which include, among other codes, revenue codes to assist providers with coding claims correctly. It can be purchased thorough National Uniform Billing Committee Web site: http://www.nubc.org/. It is called the NUBC Official UB-04 Data Specifications Manual. There is an annual fee for the manual. Providers also receive updates throughout the year.