Streamlined Medical Billing & Coding Solutions for Federally Qualified Health Centers (FQHCs)

Expert Medical Billing & Coding for Federally Qualified Health Centers — Accurate, Compliant, Profitable.

Streamlined Billing & Coding Solutions for Federally Qualified Health Centers (FQHCs)

At Everest AR Management Group, we specialize in providing end-to-end medical billing and coding solutions for Federally Qualified Health Centers (FQHCs). Our team of certified billers ensures every claim is processed accurately, efficiently, and in compliance with federal and payer guidelines — so you can focus on delivering exceptional patient care.

Dedicated FQHC Expertise – We understand the unique PPS payment system and federal compliance requirements.

HIPAA-Compliant Systems – Secure cloud-based infrastructure for patient and claim data.

Certified Coders & Billers – Proficient in CPT, HCPCS, and ICD-10 coding for FQHC operations.

Proven Track Record – 96% clean claim rate and measurable revenue growth for our clients.

What Is FQHC Billing?

FQHC Billing refers to the specialized process of submitting and managing healthcare claims for Federally Qualified Health Centers, which are community-based organizations funded by the federal government to provide healthcare services to underserved populations.

Unlike traditional medical billing, FQHC billing involves additional federal and state-specific compliance requirements, encounter-based payments, and unique reimbursement methodologies from Medicare and Medicaid.

Key Points About FQHC Billing:

FQHCs receive prospective payment system (PPS) reimbursements based on patient encounters rather than individual services.

  • Billing must align with HRSA, CMS, and state Medicaid guidelines.

  • Each claim must accurately reflect both CPT (procedural) and ICD-10 (diagnostic) codes for full reimbursement.

  • Special billing considerations include wrap-around payments, cost reporting, and sliding fee schedules.

 

How FQHC Billing & Coding Works?

At Everest AR Management Group, we follow a systematic and compliant workflow designed specifically for FQHCs:

  1. Patient Registration & Eligibility Verification
    Ensure patient demographics and insurance data are complete and verified in real-time.

  2. Encounter Documentation & Coding
    Assign correct CPT, HCPCS, and ICD-10 codes for each patient encounter based on provider documentation.

  3. Claim Scrubbing & Submission
    Use advanced billing software to identify coding errors or missing data before claim submission.

  4. Payment Posting & Reconciliation
    Record all payments from Medicare, Medicaid, and private insurers to reconcile expected reimbursements.

  5. Denial Management & Appeals
    Identify, correct, and resubmit denied claims promptly to maximize revenue recovery.

  6. Reporting & Compliance Audits
    Generate detailed financial and compliance reports for continuous improvement and federal audits.

Core Components of FQHC Medical Billing & Coding

Accurate Coding (CPT & ICD-10)
Correct procedure and diagnosis coding are critical for clean claims and PPS reimbursement.

Sliding Fee Discounts
FQHCs must apply income-based sliding fee scales for uninsured patients.

Encounter-Based Billing
Payments are tied to each qualified patient encounter, not per service.

Cost Reporting
Annual cost reports must be submitted to HRSA or CMS to ensure accurate future rate adjustments.

Wrap-Around Payments
Medicaid wrap-around payments are used to cover the difference between PPS rates and managed care reimbursements.

Compliance Management
Every billing activity must adhere to HIPAA, HRSA, and CMS guidelines to prevent penalties.

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Elevate Your FQHC’s Revenue Cycle with Everest AR Management Group.

FQHC Client Testimonials

  • “Everest AR’s deep understanding of FQHC billing completely transformed our cash flow.”

    Director, Community Health Center – Illinois

  • “They handle wrap-around payments and cost reporting better than any billing company we’ve worked with.”

    CFO, Midwest FQHC Network

  • “The transparency and communication from their team are unmatched.”

    Billing Manager, Coastal Health FQHC

Comprehensive FQHC Billing & Coding Solutions

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Benefits of Outsourcing Your FQHC Billing & Coding to Everest

Increase Reimbursement Rates – Minimize denials and capture every eligible payment.

Stay Fully Compliant – Our billing follows FQHC-specific federal and state rules.

Faster Cash Flow – Accelerated claim submission and payment posting cycles.

Reduce Administrative Workload – Focus on patient care while we handle the billing complexities.

Data-Driven Insights – Get customized reports on revenue performance and payer mix.