Final rule medicare fqhc pps
This presentation is the property of its rightful owner.
Sponsored Links
1 / 5

FINAL RULE – Medicare FQHC PPS PowerPoint PPT Presentation


  • 129 Views
  • Uploaded on
  • Presentation posted in: General

FINAL RULE – Medicare FQHC PPS. May 2014 Susan Dahl, MHA, RHIA, CHC, CHPS. Changes Medicare FQHC PPS. Published in Federal Register 5/2/14 http:// www.gpo.gov/fdsys/pkg/FR-2014-05-02/pdf/2014-09908.pdf Establish national encounter rate Move all FQHC’s to new PPS system

Download Presentation

FINAL RULE – Medicare FQHC PPS

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Final rule medicare fqhc pps

FINAL RULE – Medicare FQHC PPS

May 2014

Susan Dahl, MHA, RHIA, CHC, CHPS


Changes medicare fqhc pps

Changes Medicare FQHC PPS

  • Published in Federal Register 5/2/14

    • http://www.gpo.gov/fdsys/pkg/FR-2014-05-02/pdf/2014-09908.pdf

  • Establish national encounter rate

  • Move all FQHC’s to new PPS system

    • Cost reporting periods beginning 10/1/14

    • All moved by 1/1/16


Billing under new system

Billing under new system

  • Require HCPCS codes and facility charges

  • CMS to establish new G codes for preventive visits, annual wellness exams, IPPE, and new patients

  • Eliminate separate payment for DSMT/MNT and IPPE visits (will be billed as visit)

  • Allow payment for

    • Medical and mental health visit on same day

    • Return visit for illness/injury occurring after visit

    • Preventive physical exam and other medical visit or other mental health visit on same day


Pps rate

PPS Rate

  • Will be adjusted annually,

    • calendar year for all Medicare FQHC’s

  • $158.85 before adjustments (10/1/14)

    • GAF (geographic adjustment)

    • Adjustment for IPPE, New Patient, and Annual Wellness visit (1.3416)

    • Example for IPPE: Rate = $158.85 x GAF X 1.3416

  • Technical components not included,

    • billed separately: X-ray, lab, DME


Payment

Payment

  • Lesser of Actual Charges or PPS Rate

    • Paid at 100% for preventive services

    • 80% for other services

  • Reimbursed Separately, through cost report:

    • Reasonable costs of influenza & pneumococcal vaccines and their administration, allowable graduate medical education costs and bad debts

  • Wrap around from MAC for difference between Medicare Advantage plan and what FQHC would otherwise be entitled to


  • Login