Category: RCM Q & A

The FQHC cost report sets your PPS rate going forward. Learn why errors permanently cut reimbursement and how to protect your rate.

FQHC provider credentialing gaps turn every visit into a denial. Learn how credentialing affects reimbursement and how to protect your revenue.

FQHC Medicare Advantage billing needs two claims to capture the supplemental wraparound. Learn the TOB 77X and revenue code 0519 steps to get paid fully.

The FQHC new patient rate adds 34.16% to your PPS payment for new patients, IPPEs, and AWVs. Learn how it works and why it's often missed.

FQHC same-day billing usually allows one encounter per day, with key exceptions. Learn when a second visit is payable and how to avoid denials.

A billable FQHC visit needs a face-to-face encounter with a qualifying provider. Learn what counts, what's bundled, and where revenue is lost.

The 2026 FQHC PPS rate is $207.72, adjusted by location. Learn how the FQHC PPS rate is calculated and where centers lose reimbursement.

An FQHC wraparound payment covers the gap between managed care pay and your PPS rate. Learn how it works and why underpayments go unnoticed.

FQHCs should look for a billing partner with documented FQHC billing experience, knowledge of Medicare and Medicaid PPS reimbursement, understanding of HRSA compliance requirements, experience with FQHC cost reports, and a track record of optimizing PPS rates. Generic medical billing expertise is not sufficient for the complexity of FQHC revenue cycle management.

FQHCs are required by HRSA to offer a sliding fee discount schedule to patients at or below 200% of the Federal Poverty Level. Patients between 100–200% FPL pay a reduced fee on a sliding scale; patients below 100% FPL are charged a nominal fee. The sliding fee discount must be documented, applied consistently, and reported in the FQHC's cost reports.