Healthcare Logic provides FQHC medical billing, coding, denial management, A/R follow-up, eligibility verification, provider enrollment, payment posting, and reconciliation built around the reimbursement rules health centers actually face. Our workflows account for Medicare FQHC PPS, state Medicaid PPS or alternative payment methodologies, Medicaid MCO requirements, wraparound payments, UDS data alignment, sliding fee processes, and current CMS and HRSA billing updates.
FQHC revenue cycle management now sits at the intersection of Medicare PPS, state Medicaid PPS or APM rules, Medicaid managed care, wraparound reimbursement, provider enrollment, HRSA reporting, eligibility changes, and 340B data requirements. The most expensive failures are usually upstream problems that are discovered only after a denial, underpayment, or aged A/R balance appears.
FQHC coding errors do more than create rejected claims. Incorrect qualifying-visit logic, same-day encounter handling, revenue code mapping, modifier use, documentation gaps, or state-specific Medicaid rules can create denials and silent underpayments. Effective FQHC medical billing connects coding, charge capture, claim edits, payment variance review, and denial root-cause feedback before balances age.
Coverage problems are increasingly discovered at check-in or after claim submission, turning eligibility into a revenue-cycle issue. Federal Medicaid changes taking effect in 2026 and 2027 add new verification and renewal pressure for certain beneficiaries, while state implementation varies. FQHCs need tighter eligibility verification, coverage follow-up, patient access workflows, authorization checks, and rapid claim correction when coverage changes.
HRSA finalized CY 2026 UDS changes in September 2026, including revised patient support service reporting, new and updated clinical measures, and changes to existing data fields. Billing, EHR, payer, and quality data need to reconcile before the February 2027 submission cycle. Revenue-cycle teams that wait until year end can spend weeks correcting encounter, payer, demographic, and service data that should have been validated upstream.
Beginning October 1, 2026, CMS requires FQHCs to bill Medicare distant-site telehealth using the individual CPT or HCPCS code with modifier 93 for audio-only or modifier 95 for audio-video, rather than G2025. CMS also made FQHCs eligible for ACCESS Co-Management Payment billing on October 1. Charge masters, EHR mappings, claim edits, documentation, and staff workflows should be updated before these claims reach A/R.
Healthcare Logic reviews the billing-side impact of these changes across eligibility, coding, claim submission, denials, A/R, payment reconciliation, and reporting. Official references: CMS FQHC/RHC News & Announcements and HRSA 2026 UDS Technical Assistance.
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Healthcare Logic delivers FQHC revenue cycle management services from patient access through final payment. The model combines FQHC medical billing, coding, eligibility, credentialing, prior authorization, payment posting, denial management, A/R follow-up, underpayment review, and reconciliation with state-specific Medicaid and Medicare FQHC billing rules. This is the health-center delivery model for our Revenue Cycle Management & Medical Billing Services.
Medicare FQHC PPS billing, state Medicaid PPS or APM workflows, qualifying-visit validation, same-day encounter rules, payer-specific claim edits, and current telehealth billing requirements. We manage claim preparation and submission so encounter logic, revenue codes, modifiers, and payer rules are aligned before the claim leaves the system.
Real-time eligibility and benefits verification, Medicaid coverage and renewal checks, sliding fee documentation support, prior authorization status, and payer enrollment monitoring. We connect front-end eligibility and provider credentialing issues to the claims and dollars they place at risk, rather than waiting for enrollment or coverage denials to surface in A/R.
FQHC coding services for medical, dental, and behavioral health encounters, with documentation review, charge capture, encounter validation, and payer-specific coding controls. Billing data is structured to support CY 2026 UDS reporting so patient, payer, visit, and service information can be reconciled before the annual submission cycle.
ERA and EOB posting, remittance reconciliation, Medicaid wraparound and supplemental payment tracking, underpayment identification, credit balance review, and billing-side 340B data support. Our goal is to make the path from claim to cash visible enough for finance teams to reconcile what was billed, what was paid, and what still needs action.
State-specific Medicaid MCO billing, prior authorization, referral requirements, payer edits, timely filing, encounter submissions, and plan-specific follow-up. Where applicable, we reconcile MCO payments against state FQHC wraparound or supplemental reimbursement so managed care collections are not treated as complete simply because the primary claim paid.
FQHC denial management, appeals, aged A/R follow-up, payer escalation, no-response claims, underpayment review, and recovery prioritization by payer, age, root cause, and collectibility. Repeated denial patterns are pushed back upstream to eligibility, credentialing, coding, documentation, authorization, or claim configuration so the same problem does not keep returning to the work queue.
Our FQHC RCM workflow follows the claim from eligibility and provider enrollment through coding, submission, payment, denials, A/R, wraparound reconciliation, and reporting. Every stage is designed to identify revenue leakage early and give finance and operations teams a clear reason when cash is delayed.
FQHC finance and operations teams need more than production counts. They need to know where revenue is sitting, why a claim failed, what is recoverable, which payer or location is driving the variance, and what should change upstream. Healthcare Logic structures FQHC RCM around that visibility while working inside the client's EHR, practice management, clearinghouse, and payer workflows.
We work across Medicare FQHC PPS and state-specific Medicaid reimbursement, including PPS, APMs, MCO billing, qualifying encounters, wraparound payments, telehealth rules, and payer-specific claim requirements.
We do not treat every denial as an isolated follow-up task. Repeated patterns are traced back to eligibility, enrollment, coding, documentation, authorization, claim edits, payer configuration, or filing limits so preventable denials stop re-entering A/R.
Reporting is organized around actionable revenue-cycle questions: A/R by payer and age, denial root cause, underpayments, eligibility failures, credentialing holds, wrap balances, cash posting, and recovery status. The objective is decision-ready visibility, not another spreadsheet of transaction counts.
We connect billing records with UDS data needs, MCO payment detail, state wraparound reimbursement, remittance posting, credit balances, and cost-report support so unresolved variances are visible before year-end reconciliation turns them into a finance project.
FQHC revenue cycle management can span patient access, eligibility verification, provider enrollment and credentialing, medical coding, charge capture, Medicare and Medicaid claim submission, payment posting, Medicaid MCO and wraparound reconciliation, denial management, A/R follow-up, underpayment review, credit balance resolution, and reporting. Healthcare Logic configures those workflows around the health center's actual payers, sites, providers, and reimbursement methodology.
HRSA finalized CY 2026 UDS changes in September 2026. The changes include revised patient support service reporting, new and updated clinical measures, changes to existing data fields, and updated eCQM alignment. Health centers will report CY 2026 data in the 2027 submission cycle, so billing, EHR, payer, demographic, and service data should be reconciled before year end. See the HRSA 2026 UDS resources.
We review documentation, charge capture, encounter classification, qualifying-visit logic, payer rules, and coding requirements across medical, dental, and behavioral health services. Same-day billing, Medicaid reimbursement, and covered-service rules can vary by payer and state, so the coding workflow is configured to the health center's actual contracts, sites, providers, and service lines.
Yes. Based on the health center's state and contracted plans, we support Medicaid MCO eligibility, prior authorization, claim submission, timely filing, denial follow-up, payment posting, and payer-specific requirements. Where the state's FQHC methodology includes supplemental or wraparound reimbursement, we reconcile MCO payment detail against the additional amount due so the primary managed-care payment is not treated as the end of the revenue cycle.
Healthcare Logic supports the billing-side data needed for 340B operations, including encounter, payer, eligibility, payment, and reconciliation information. We do not administer the 340B program itself. HRSA's revised 340B Rebate Model Pilot is scheduled to begin January 1, 2027 for a limited set of drugs, increasing the importance of clean claims-level and transaction-level data for affected covered entities. See HRSA's 340B pilot information.
We verify active coverage, plan and benefit information, Medicaid status, referral and authorization requirements, and other payer details before billing. We also support the billing-side alignment of sliding fee documentation and patient account status. Federal and state Medicaid eligibility changes in 2026 and 2027 make front-end verification and rapid coverage follow-up increasingly important for preventing avoidable denials and self-pay balances.
Medicare pays FQHCs under the FQHC Prospective Payment System, while state Medicaid programs use state-specific PPS or alternative payment methodologies and may include managed-care and wraparound payment rules. Correct reimbursement depends on qualifying visits, encounter classification, coding, revenue codes, provider and site enrollment, payer-specific edits, and state rules that do not apply to a typical physician practice.
Beginning October 1, 2026, CMS requires FQHCs to bill Medicare distant-site telehealth using the individual CPT or HCPCS code that describes the service instead of G2025. FQHCs also report modifier 93 for synchronous audio-only services or modifier 95 for synchronous audio-video services. This change requires updated charge capture, coding, claim edits, and staff workflows. See CMS FQHC/RHC guidance.
We segment denials and aged accounts receivable by payer, age, root cause, collectibility, and next action. The team works appeals, payer follow-up, no-response claims, underpayments, authorization issues, enrollment holds, coding corrections, and timely-filing risk while feeding recurring problems back to eligibility, credentialing, coding, documentation, and claim configuration so the same denial does not keep returning.
An FQHC RCM partner should understand Medicare FQHC PPS, state Medicaid reimbursement, Medicaid MCO and wrap workflows, coding, provider enrollment, eligibility, denials, A/R, and health-center reporting. Leadership should also receive transparent reporting that explains where revenue is sitting, why cash is delayed, what is recoverable, which issues need escalation, and what operational change will prevent the problem from recurring.
Get a focused FQHC revenue cycle assessment covering eligibility, provider enrollment, coding, claim edits, denials, aged A/R, payment posting, Medicaid MCO and wraparound reconciliation, and reporting. The objective is simple: show where revenue is delayed, why it is delayed, and what should change upstream.
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