Coding and Billing Guidelines for FQHCs


About Course

Conference Material (Password Required)

During this Webinar, we will discuss the basics of FQHCs for coding and billing. We will review the Medicare G codes and the qualifying codes/services that correlate with the G codes. We will also outline the FQHC billing requirements for multiple visits on the same date of service. We will discuss when a patient is considered a new patient versus an established patient in an FQHC. The training will also outline which services go on which claim form (i.e., UB versus 1500) for Medicare. This webinar will leave plenty of time for questions to be answered during the training.

Learning Objective:

  • The attendees will be able to determine if a CPT/HCPCS code is considered a qualified code for Medicare.
  • The attendees will be able to identify when multiple visits are allowed to be billed on the same date of service.
  • The attendees will understand when a patient is considered new or established for Medicare in the FQHC setting.
  • The attendees will know which claim should be submitted for each CPT/HCPCS code.

Areas Covered in the Session:

  • G codes and Qualifying Codes
  • Multiple visits on the same date of service
  • New vs. Established patients
  • Which claim form to submit
  • Qualified Provider
  • Covered Services
  • Coding & Compliance Initiatives – Location
  • Coding & Compliance Initiatives – G codes
  • Qualifying Codes for G0467 (established patient)
  • Qualifying Codes for G0468 (IPPE or AWV)
  • Qualifying Codes for G0469 (mental health – new patient)
  • Example – New Patient
  • Example – Established Patient
  • Multiple Visits
  • Example – Medical and Mental Health
  • Billing Requirements
  • Billing Requirements – Multiple Visits
  • Claims
  • Denial Needed
  • Covered or Non-Covered Service
  • Four Categories of Items and Services NOT Covered under Medicare
  • New Patient – Payment Adjustment
  • Electrocardiogram (EKG)
  • Ancillary Services
  • Laboratory Services
  • Technical Component

Suggested Attendees:

  • Credentialing and Enrollment Specialists
  • Credentialing and Enrollment Experts
  • Credentialing and Enrollment Leaders
  • Healthcare Administrative Teams, Personnel
  • Practice Managers
  • Healthcare Billing Specialist
  • Staff Providing NPI Support, NPPES  Support
  • Staff Providing CAQH Support
  • Clinic Managers
  • Allied Health Providers
  • Advance Health Practitioner
  • Credentialing
  • Enrollment
  • Office Managers
  • Operations
  • Revenue Cycle
  • Coders
  • Clinical Directors
  • Practice Owners
  • Claims Teams
  • MSPs

About the Presenter

Ms. Sulzberger is a Licensed Practical Nurse and a Certified Professional Coder. She received her Bachelor of Science degree in Business Administration from Mid America Nazarene University. Ms. Sulzberger received her nursing license in 1994 and was a practicing clinician at Saint Luke’s Health System for several years before transferring to the internal compliance/audit area. She became credentialed as a Certified Professional Coder in 1996 and assisted the Saint Luke’s Health System with performing medical record chart audits to verify the accuracy of the internal coding and claims processing.

Ms. Sulzberger spent approximately six years as a coding/billing consultant with National accounting and consulting firms (BKD, Grant Thornton) before becoming the President of Coding & Compliance Initiatives, Inc. (CCI) in April 2003. Ms. Sulzberger assists her clients with improving their operational performance in a variety of critical outcome areas, including coding/billing, corporate compliance, charge capture processes, etc. Ms. Sulzberger works with a variety of health care providers including hospitals, physician practices, and rural health clinics in their daily compliance and operational activities.

A substantial amount of Shellie’s time is spent providing education to the physicians and internal coding staff regarding opportunities for the clinic to improve its current documentation and coding practices, which impact both the revenue and compliance risk of the facility.

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
  • Course Key
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