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Tools

Medicare and Medicaid reimbursement program options for clinic evaluation and Management (E&M) services:

			Federally Qualified Health Center
	Provider Based Clinic	Rural Health Clinic	FQHC Look Alike	FQHC Section 330
Requirements:
Rural designation		X
Community run board			X	X
Underserved designation		X	X	X
Operation as a hospital outpatient department	X
Minimum staffing productivity standards		X	X*	X*
Indepentent status - all inclusive cost cap applies		X	X*	X*

Reimbursement advantage - Provider based designation
All hospitals - Split bill Medicare - professional services and facility APC	X
Critical access hospitals - 15% bonus payment on Medicare professional services (method 2 billing)	X
Critical access hospitals - Cost based Medicare and Medicaid reimbursement		X
Hospitals - Less than 50 beds - Medicare and Medicaid Cost based reimbusement without cost cap		X

Reimbursement advantage - independent Clinics:
Medicare and Medicaid Cost based reimbursement with cost cap		X	X	X
Tribal FQHC's - Medicare and Medicaid Cost based reimbursement without cost cap				X
Qualify for 3408 program - reduced cost medications			X	X
Medicare Part B patient deductable waived			X	X
Excluded from tort liability				X

*	Scheduled for replacement with a prospective system for FQHC's under The Patient Protection and Affordable Care Act. 2010 limits are RHC $77.76 FQHC rural $108.81 FQHC urban $125.72 per the Social Security Act 1833(f)

Health Consulting Partners
PO Box 10653 Green Bay Wisconsin 54307-0653 866-935-5868 info@health-cp.com