PPS and AIR-Based Encounter Billing
PPS claims require clean documentation, correct G-codes, CG modifier logic, and 1-encounter-per-day rules. We verify eligibility, scrub encounters, code correctly, and protect your full PPS/AIR reimbursement.
FQHC Billing Services Built for PPS, AIR & HRSA Compliance
Full-spectrum billing solutions tailored to encounter-based reimbursement, wraparound payments, Medicaid MCO rules, and federal reporting requirements. We help FQHCs reduce administrative burden, stay compliant, and improve revenue performance.
Dedicated to Serving FQHC, CHC & Rural Health Providers
With expertise in medical billing and revenue cycle management, we serve a wide range of community-based healthcare providers:
Family Practice and Primary Care
Behavioral and Mental Health
Women’s Health and OB/GYN
Internal Medicine
Pediatrics
Dental and Oral Health
Our systems are built for PPS logic, CG modifiers, G-codes, wraparound reconciliation, UDS requirements, and Medicaid APM variations across states.
Behind Every Clean Claim Is Our AI‑Powered Billing Engine
Our billing platform applies payer-specific edits, encounter logic, CG modifiers, and compliance checks before submission. This protects your PPS/AIR claims, wraparound reimbursement, and federal compliance.
This includes specialized support for:
Substance Use Disorder and Medication-Assisted Treatment (MAT)
HIV/AIDS Care and Ryan White Program Billing
Chronic Care Management (CCM) and Remote Patient Monitoring (RPM)
Vision and Optometry Services
Mobile Health Units and School-Based Clinics
Lab and Diagnostic Services
Vaccination Clinics and Public Health Programs
Care Coordination and Case Management Support
Core FQHC Billing Solutions
Our FQHC community health center billing services support every stage of the revenue cycle, from patient registration to claim submission and final payment reconciliation.
Medicare and Medicaid Billing
Different payers, different rules — and missed steps delay payments. We apply PPS base rates with GAF adjustments for Medicare, handle state APMs for Medicaid, and process crossover claims cleanly so your cash flow stays steady.
Medicaid Wraparound Reconciliation
MCO payments rarely match PPS rates. We track variances, prepare wraparound reports, and submit all eligible claims so you recover the full difference owed.
Sliding Fee Scale Compliance
Incorrect sliding fee implementation creates HRSA audit findings. We post discounts accurately, map charges to board-approved fee schedules, and maintain audit-ready documentation.
Telehealth Billing for FQHCs
Telehealth claims get denied if billed wrong. We apply G2025 for Medicare visits, use CMS-approved codes for remote behavioral health, and validate modifiers, time, and credentials before submission.
Behavioral Health Integration (BHI)
We bill BHI under CMS guidance using the correct G-codes and documentation logic for counselors, LCSWs, and peer support staff.
Provider Credentialing
Eligibility denials often trace back to bad enrollment. We credential physicians, NPs, dentists, and behavioral health providers across Medicare, Medicaid, and MCOs with correct taxonomy and location mapping.
UDS Reporting Alignment
Bad data in billing leads to compliance issues in UDS. We map provider roles, visit types, and payer classes at charge entry, and generate UDS-ready exports to avoid manual cleanup during audits.
Denial Management
FQHC denials usually stem from coding errors. We fix CG modifiers, missing G-codes, and duplicate encounters, while applying payer-specific edits so resubmissions get paid.
Per Diem Billing
State Medicaid per diem rules are strict. We consolidate daily encounters into one claim, verify time and medical necessity, and flag overlaps to prevent denials.
Off-Site and Mobile Unit Billing
Claims from schools, shelters, and mobile units often get rejected. We bill with POS 15 or 99, confirm HRSA-approved sites, and link providers to the right location to keep claims clean.
Compliant with Every State & Federal Rule
FQHC billing is not one-size-fits-all. Every state has its own Medicaid rules, payment systems, and billing requirements. Whether you run a single clinic or manage multiple locations, we make sure your billing follows both federal PPS guidelines and your state’s Medicaid policies.
Our team works with:
Medi-Cal in California, including managed care billing
Texas Medicaid, covering both fee-for-service and MCO plans
New York’s APG system for FQHC reimbursement Wrap-around payment programs in Oregon and Washington
Florida’s SMMC program and its billing updates for FQHCs
This keeps your federally qualified health center (FQHC) RCM on track.
How We Optimize Your Financial Health and Reimbursements
Actionable Revenue Cycle Insights
Avail real-time dashboards and detailed reports that track cash flow, claim status, denial trends, and key performance metrics. This helps FQHCs make informed decisions and maximize reimbursements.
Simple and Affordable Pricing for FQHCs
We use a per-encounter pricing model with no setup costs. This provides FQHCs with a clear budget, comprehensive billing support, and compliance-ready workflows, all without incurring additional costs.
Strategic Accounts Receivable Recovery
We track unpaid or denied claims, fix coding or modifier errors, and resubmit them to the right payer. This includes PPS, APM, per diem, and wraparound billing to help you collect every dollar you have earned.
Why Choose Us As Your Medical Billing Company?
Enhance your revenue operations with technology, streamlined processes, and experts who understand your organization’s needs. We work closely with your team to identify gaps and improve revenue capture.
Flexible Solutions That Scale
Certified FQHC Coders
Nationwide CMS & Medicaid Compliance
Improve Revenue Collection
Reduce Administrative Overhead
Frequently Asked Questions
What are your FQHC billing services, and why do they matter?
Our FQHC billing solutions are designed to streamline the payment process for Federally Qualified Health Centers (FQHCs) that provide care. These services include coding, claim submission, payment tracking, and reporting, all while following specific CMS and HRSA guidelines. Since FQHCs follow a unique payment system called PPS, accurate billing is crucial to ensuring they receive full reimbursement for medical, dental, behavioral health, and preventive care.
How is FQHC billing different from regular medical billing?
FQHCs don’t bill each service separately, unlike private practices. Instead, they use the Prospective Payment System (PPS), which pays a fixed amount per patient visit. To get paid correctly, the visit must meet certain rules and include approved G-codes. FQHCs often serve multiple care types, so billing must bundle services, such as primary care and behavioral health, into a single, clean, and compliant claim.
What does the PPS model cover in FQHC billing?
Under PPS, FQHCs are paid a single rate per visit, regardless of the number of services provided during that visit. This includes preventive care, medical exams, laboratory work, and mental health services. These rates are reviewed by CMS and adjusted yearly. Each state may have different Medicaid payment rules, so staying current is important to avoid underpayment.
How do FQHCs get paid by Medicare and Medicaid?
FQHCs get reimbursed in two main ways. Medicare pays a fixed rate per visit through the PPS model using specific G-codes. For Medicaid, states often provide wrap-around payments, which are extra payments that cover the gap between Medicaid rates and the PPS rate. Submitting claims on time and including all required details helps ensure full and fast reimbursement.
Which codes are used in FQHC billing services?
The most common codes used in FQHC billing are G-codes. For example, G0466 is used for new medical visits, and G0511 or G0512 are used for behavioral health services. Some Medicaid programs also require T-codes or special state-level modifiers. Using the correct codes and applying modifiers properly helps avoid delays, denials, or reduced payments.
What does our FQHC billing workflow include from visit to payment?
Our billing workflow covers every step of the revenue cycle:
- Insurance verification before the appointment
- Accurate documentation by providers
- Coding each visit using PPS-approved G-codes
- Submitting clean claims to Medicare, Medicaid, and commercial payers
- Tracking payments and posting them quickly
- Managing denials and resubmitting corrected claims
- Generating UDS and internal KPI reports for performance tracking We follow this process for every client to ensure timely payments and maintain compliance.
How can you help FQHCs reduce denials and get paid more quickly?
We start by analyzing your past denials to identify patterns such as missing modifiers or incorrect codes. Our certified coders then apply the correct edits before the claim goes out. If a denial happens, we act fast. Our team reviews and corrects the claim. We also utilize automated tools to identify common issues early, resulting in fewer claims being rejected.
Why outsource FQHC billing services to your team?
FQHC billing is complex, and not every billing team understands PPS rules, Medicaid variations, or HRSA compliance. Our team specializes in revenue cycle management for community health centers (CHC). We reduce your administrative burden, improve claim accuracy, and ensure compliance with CMS updates. With our help, clients often see fewer denials, faster payments, and better control over their revenue cycle.