Care Coordination Services for FQHC/RHC Claims Improperly Paid
JK and J6 FQHC and RHC
Description of Issue
Care coordination services for FQHC and RHC providers are being reimbursed incorrectly. According to CR 13581, they should be paid at the national nonfacility fee rate, but FISS is using the facility fee rate.
National Government Services Action
NGS analysts reported the issue to CMS and FISS, who are now working together to ensure that care coordination services codes, as outlined in CR 13581, are reimbursed at the nonfacility rate. Furthermore, the coinsurance calculation for RHC claims will be adjusted to be based on the lesser of the fee schedule or the charge, instead of just the submitted charges.
Provider Action
Review CR 13581: Updates to Billing for Care Coordination Services for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for coding details. No other action is indicated.
Proposed Resolution/Fix
TBD