9-10-18 NAMAS Webinar FQHC & RHC Auditing

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

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Joined: Mon Sep 10, 2018 12:55 pm

Mon Sep 10, 2018 3:42 pm

Hello all,

Thank you to those who attended our NAMAS "FQHC & RHC Auditing: What You Need to Know" webinar today! For those of you who asked questions live and were unable to receive answers, Gary has responded to each and the list is compiled below. If you have any follow up questions, please feel free to contact the speaker directly or send them to us at namas@namas.co. Thank you!

Disclaimer: These questions were copied and pasted without and editing for grammar, spelling, or clarity, directly from the webinar Q&A feed. The answers were compiled after the fact by the webinar speaker and answered in line, per question.

Q: How should I bill for patients presenting for breast and cervical exam only, also can I bill for the scoring of an vanderbilt=CPT 96127?
A: I would have to know if they are an FQHC or RHC and if it is to Medicare or traditional 3rd party insurers? Here are a few links that will help with general coding/billing:
https://www.connectedmind.me/articles/2 ... sage-guide
https://aims.uw.edu/sites/default/files ... ding_0.pdf

Q: When a new provider joins the fqhc, and he has seen the patient before, the patient is considered new, correct?
A: I would say yes based on this FQHC FAQ document from CMS. Look in the New Patient section question #6 here:
https://www.cms.gov/Medicare/Medicare-F ... S-FAQs.pdf

Q: For an RHC Medicare claim, does it matter which order the CG and the 25 modifier are in when billing? Should the CG should go first as it identifies the claim as an RHC claim with the 25 second for billing purposes, or, do we even need to use a 25 modifier at all since the service is paid under the AIR?
A:Excellent question! The -CG almost assuredly goes first and you are right, modifier -25 is usually not going to be needed on a Medicare claim since you are not bound by Medicare's global billing rules. You simply report the document and supported E/M and the procedure and report everything together!

Your questions have been answered by webinar speaker Gary Lucas, MSHI
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