Medicare Boot Camp®—Federally Qualified Health Center Version

Overview

Master the Complexities of FQHC Billing, Compliance, and Reimbursement

Federally Qualified Health Centers (FQHCs) face a unique set of challenges when billing Medicare, from navigating complex coding requirements to addressing eligibility and coordination of benefits. The high-risk nature of serving both insured and uninsured populations makes accurate billing crucial to avoid financial pitfalls and ensure proper reimbursement.

The Live Virtual Medicare Boot Camp®—Federally Qualified Health Center Version is an intensive two-day course that will provide comprehensive education on Medicare coverage, coding, billing, and payment regulations and guidelines for Federally Qualified Health Centers (FQHCs).

Our expert instructors provide in-depth education on common issues—eligibility problems, coding for non-qualifying visits, date of service errors, and incorrect coding, and more—that lead to rejected or denied claims, extend accounts receivable days, and impact your revenue cycle.

What You’ll Learn:

• Identify and manage non-qualifying visits: Learn how to recognize services that do not meet Medicare's criteria for qualifying visits and understand how to correctly document, code, and bill for these services to minimize rejections and ensure proper reporting.
• Master FQHC-specific coding requirements: Learn how to accurately use HCPCS codes for qualifying visits and properly pair them with CPT codes to meet Medicare’s unique billing requirements for FQHC and non-FQHC services, minimizing claim rejections and delays in reimbursement.
• Navigate claims for dually eligible beneficiaries: Learn how to coordinate benefits for patients with both Medicare and Medicaid, minimizing rejections due to eligibility or payer issues.
• Bill for telehealth and mental health services: Stay updated on recent regulatory changes and how to correctly bill for these high-demand services under Medicare’s evolving rules.
• Navigate "incident-to" billing complexities: Understand the specific requirements for billing "incident-to" services in FQHCs, including supervision rules, documentation standards, and the differentiation between bundled services and those eligible for separate billing, ensuring compliance and ensuring reimbursement.
• Gain comprehensive knowledge of the CMS-1450 (UB-04) claim form: Learn how to report multiple payment codes, navigate the Integrated Outpatient Code Editor (IOCE), and submit claims for dually eligible beneficiaries and Medicare Advantage plans, ensuring accurate billing and compliance.
• Differentiate between FQHCs and RHCs: Understand the differences in billing, coding, and reimbursement between Federally Qualified Health Centers and Rural Health Clinics (RHCs).

Take Action
Don’t let claim rejections and denials keep your FQHC from receiving the payments it deserves. HCPro's Medicare Boot Camp provides in-depth, practical training on Medicare’s ever-evolving billing requirements and equips you to overcome the specific challenges faced by FQHCs.

Register today to secure your spot in this essential training program tailored specifically for Federally Qualified Health Centers!

Looking to train your whole team? Our experts can provide virtual training for your organization! Learn more here!

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

Medicare Boot Camp®—Federally Qualified Health Center Version

Course Outline

Module 1: Review of Medicare Contractors, Research, and Resources

• Overview of Medicare Parts A, B, C, and D
• Role of Medicare contractors
• Medicare source laws, including statutes and regulations
• Medicare subregulatory guidance, including manuals and transmittals
• Links to Medicare information and resources for staying current

Module 2: Review of Medicare Coverage Guidance and the Advance Beneficiary Notice

• Medicare Coverage Center, including NCDs, LCDs, and Laboratory Manual
• Coverage of drugs, including self-administered drugs
• Limitations of liability statute and notice requirements
• Advance Beneficiary Notice and instructions

Module 3: Designation as an FQHC, Including Required Practitioners and Services

• Definition and purpose of an FQHC
• Differentiating between an FQHC and an FQHC look-alike
• Certification criteria, including location, staffing, and required services
• Requirements for services furnished by the FQHC or incident to an FQHC practitioner
• Services excluded from the FQHC benefit
• Distinguishing between an independent and a provider-based FQHC

Module 4: General Billing Requirements for FQHCs

• Overview of the CMS-1450 (UB-04)
• Claims processing requirements, including type of bill, revenue codes, HCPCS codes, modifiers, and charge reporting
• Global billing and the applicability to FQHCs
• Reporting multiple specific payment codes (G codes)
• Integrated Outpatient Code Editor and the applicability to FQHCs
• HCPCS coding specific to Medicaid
• Claim submission for dually eligible beneficiaries
• Billing for supplemental payments to FQHCs under contract with Medicare Advantage plans

Module 5: Coverage and Billing of FQHC Visits

• Medical and mental health visits
• Special services: diagnostic services, vaccines, injections, and other incident-to services
• Laboratory services
• Preventive health services
• Care management services
• Diabetes self-management training and medical nutrition services
• Hospice attending physician services
• Dental, podiatry, optometry, and chiropractic services
• FQHC practitioners and Appropriate Use Criteria

Module 6: Coverage and Billing of FQHC Services Provided Outside the FQHC

• Visiting nurse services
• Telehealth services
• Virtual communications

Module 7: Reimbursement Principles for FQHCs

• Identification of qualifying visits for payment purposes
• FQHC PPS payment rate and adjustments
• FQHC-specific payment codes
• Application of the Medicare Part B deductible and coinsurance
• Graduate medical education payments

Course agenda/outline is subject to change.

Medicare Boot Camp®—Federally Qualified Health Center Version

Learning Outcomes

• At the conclusion of this educational activity, participants will be able to:
• Summarize the Medicare program, benefit categories, and the role of the Medicare functional contractors
• Locate and apply Medicare law, regulation, and subregulatory guidance for claim submission, appeal, and audit defense
• Locate and identify national and local coverage determinations and explain their role in medical necessity
• Understand the Advance Beneficiary Notice, its instructions, and appropriate use
• Explain and summarize the definition of an FQHC
• Analyze the FQHC requirements related to location, staffing, and required services
• Differentiate between FQHC and non-FQHC services
• Compare and contrast FQHCs and FQHC look-alikes
• Identify FQHC qualifying visits and summarize the importance of accurate reporting
• Examine Medicare “incident-to” and supervision requirements for services performed in an FQHC
• Understand Medicare’s FQHC billing and coding requirements, illustrating an understanding of bill type, revenue, HCPCS codes, and modifiers
• Identify and accurately bill for non-FQHC services, demonstrating an understanding of the appropriate Medicare benefit category and Medicare payment methodology
• Interpret integrated outpatient code edits applicable to FQHCs
• Examine and appropriately use FQHC-specific payment codes
• Analyze claim submission requirements for dually eligible beneficiaries
• Understand the FQHC prospective payment methodology (FQHC PPS), accurately determining Medicare reimbursement and patient cost sharing
• Summarize the billing process for supplemental payments to FQHCs under contract with Medicare Advantage plans
• Differentiate requirements, coding, billing, and reimbursement principles of clinics, RHCs, and FQHCs

Continuing Education

*Coming Soon! 

Disclosure Statement:
HCPro has confirmed that none of the faculty/presenters, planners, or contributors have any relevant financial relationships to disclose related to the content of this educational activity.

Medicare Boot Camp®—Federally Qualified Health Center Version

Things to Know Before Attending Class

Directions and Hotel Information

The hotel address, phone number, URL, room rate, and room rate cut-off date are posted on our website at https://hcmarketplace.com/product-type/boot-camps/medicare. The hotel website gives detailed directions to the hotel as well as information about the location. Please call the hotel directly to make a room reservation. Be sure to identify yourself as an HCPro Boot Camp participant. Please be sure to make your reservation before the cut-off date. After the cut-off date, contact the hotel to determine room availability and rates.

Directions and Hotel Information

The hotel address, phone number, URL, room rate, and room rate cut-off date are posted on our website at https://hcmarketplace.com/product-type/boot-camps/medicare. The hotel website gives detailed directions to the hotel as well as information about the location. Please call the hotel directly to make a room reservation. Be sure to identify yourself as an HCPro Boot Camp participant. Please be sure to make your reservation before the cut-off date. After the cut-off date, contact the hotel to determine room availability and rates

Course Materials

When you arrive at class, you will receive extensive workbooks containing the class materials utilized throughout the Boot Camp. The workbooks will be yours to keep, so plan accordingly in allowing enough room in your luggage on the return trip home. Workbooks may also be shipped from the hotel at your own expense.

Classroom Time

We will be in class from 8:00 a.m. to 4:15 p.m. on the first day of class, then from 8:00 a.m. to 3:45 p.m. on the second day of class. There will be a one-hour lunch break each day. If the class gets behind on either day, it may run later than the scheduled ending time.

Lunch 

We will take a one-hour break for lunch each day. Although we typically provide coffee in the morning and drinks and snacks in the afternoon, everyone is on their own for lunch. Note that many hotels do not have restaurants on-site. If you are flying to the course, we generally recommend renting a car.

What to Bring to Class 

We recommend you bring the following to all classes:

• Highlighter and pen/pencil
• A notebook for making your own notes
• Sticky notes/flags

Use of Laptop Computers or Electronic Devices

Our instructors demonstrate where to find many resources on the CMS website. If you have access to a laptop or tablet, you may bring it to class to follow along, but you may wish to consider the power and wireless needs of your device. Many conference rooms do not have plugins situated conveniently to the tables, so you may wish to ensure you have sufficient battery power. HCPro does not purchase group wireless access for the conference rooms, but many hotels provide free wireless access. You may wish to confirm your connectivity options prior to arriving at the hotel. Please be courteous in your use of electronic devices. Use of electronic devices should not disrupt the class or disturb other participants. HCPro is not responsible for lost, stolen, or damaged devices. Maintaining the security and safety of your device is your responsibility. Cell phone use during class is strictly prohibited.

Dress

Business attire is not necessary. Please dress comfortably. Also, we find that the classrooms are sometimes on the cool side, even during the warmer months. You may be more comfortable if you bring a sweater or sweatshirt in case you get cold.

Copyright Protection of Course Materials

You will receive a complete copy of our course materials at the beginning of class. The materials used were custom designed by our company specifically for use in connection with this course. We have invested a tremendous amount of time, money, and effort in developing, refining, and maintaining these materials, and they are protected by copyright laws. Course materials may not be duplicated. You may use the materials (i) in direct connection with the course or (ii) as a personal reference in your day-to-day work. No claim is asserted to any U.S. Government, American Medical Association, or American Hospital Association works included in the course materials workbook.

Cancellation and Transfer Policy

For our cancellation and transfer policy, visit our website: https://hcmarketplace.com/cancellations

Contact Information

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

We look forward to having you in class!

Medicare Boot Camp®—Federally Qualified Health Center Version

Questions and Answers

What is the focus of the Medicare Boot Camp®—Federally Qualified Health Center Version?
The Medicare Boot Camp—Federally Qualified Health Center Version is an intensive two-day course that will provide comprehensive education on Medicare hospital coverage, coding, billing, and payment regulations and guidelines for Federally Qualified Health Centers (FQHC).

Where is the course offered?
Open registration sessions are offered at various locations around the country, typically at mid-priced business hotels such as HYATT Place or Hilton Garden Inn. For a current schedule of upcoming open registration courses, click on "Locations/Dates" above.

Does HCPro offer an "on-site" version of this Boot Camp?
In addition to our open registration courses, we also offer this Boot Camp as an on-site program (with a substantial discount) for organizations that have a number of employees who need training. For more information on hosting an on-site Boot Camp, click on Host an On-Site Course.

What if I need to cancel or transfer my registration?
To view our cancellation policy, click here.

Who typically attends Medicare Boot Camp—Federally Qualified Health Center Version?

• Auditors and analysts
• Billing specialists 
• Chief financial officers 
• Clinic managers 
• Coding specialists 
• Compliance officers 
• Finance and reimbursement managers 
• FQHC clinic revenue cycle, compliance, case management, and clinical personnel 
• Healthcare consultants, CPAs, and lawyers 
• Health plan financial analysts, claims processing, and provider relations professionals 
• Medicare Administrative Contractors 
• Patient access/front office staff  
• Physician advisors 
• Recovery audit coordinators 

What material does the course cover?
To view the course outline, click on "Course Outline" above.

Does the course require any previous experience or training?
No. The course starts with Medicare fundamentals and does not assume that participants have any particular background or experience.

How is the course taught?
The course is taught using a combination of lecture, class discussion, and hands-on exercise/case studies.

What do I need to bring to class?
When you arrive at class, you will receive an extensive notebook of course materials. In addition, please bring the following to all classes:

• A highlighter
• A notebook for taking notes
• Sticky notes/flags
• A pen/pencil

Does HCPro ever share contact information (e.g., name, address, phone number, email address, etc.) with other companies?
Historically, we have not shared contact information with anyone outside of our company. However, it is possible that at some point we might share contact information with other companies that offer products and services that we think would be of interest to our customers. If you would like us to keep your contact information confidential, please let us know so that we can flag your information in our customer database as "Do Not Share."

How do I get more information?
Contact us at 615-724-7200 or email sales@hcpro.com.