For clinics that are chartered under Title 330, CHCSuite™ developed a set of billing enhancements that are integrated into Practice Management to enable the CHC to:
Designate the primary FQHC Insurance Carrier (usually the state Medicaid carrier) and record:
The FQHC visit rate for patient visits where the Medicaid carrier is primary.
The FQHC billing code and wraparound rate where the Medicaid carrier is secondary to Medicare
An HMO capitated plan
Other state plan where the FQHC subsidy is recoverable by “wraparound billing”.
Manage a prospective payment system that enables a CHC to accurately determine the appropriate wraparound rate and change it prospectively so that maximum cash flow can be derived without causing an unexpected liability to the clinic for overpayment at the end of a fiscal period. This is done through on-demand reports that analyze reimbursements received from qualified FQHC sources (capitation, fee for service charges and wraparound payments) against amounts due for FQHC qualified visits.
Determine the Sliding Fee applicable to a patient if the Sliding Fee applies to the visit. At the point that the patient’s portion of the fee due is determined, all fee balances are adjusted and detailed records are maintained in the system. This enables you to report and analyze Sliding Fee net revenue and the amount of fees that were adjusted on Sliding Fee encounters
CHCSuite™ applications evaluate each patient encounter, determine whether it is an FQHC visit, determine whether the FQHC billing procedure has been entered on the record, and create the FQHC record with the stated reimbursement rate in the visit record.
If the FQHC carrier is a secondary carrier, the appropriate wraparound code is entered into the encounter billing file and the wraparound rate is billed. The fee schedule (which is applied to the FQHC carrier) automatically adjusts the usual and customary fee relating to all procedures other than FQHC and records as a receivable the FQHC fee. Complete accounting is available in the system so that you can analyze FQHC activity and compare it to other program revenue.
