FQHC Billing Several Scenarios - Medicare Primary and Medicaid Secondary

[MonicaS17]

Hello everyone. I am hoping that some of our experienced FQHC Billing folks can help me wrap my mind around some questions I have with FQHC Billing. I understand all the guidelines from Medicare and Medicaid independently. However, we have all heard that we shouldn't change coding between payers. So, how do we bill the G0467 (and other Medicare FQHC G codes) to Medicare as primary on the UB, then send the remaining balance to Medicaid as the secondary on a HCFA with the T1015 code? Do we include the Medicare G code and the T1015? When there are more than one G code, like for PCP and MH on the same day, do we combine the amounts for the T1015? I am slightly at a loss and want to make sure I am setting this up correctly and compliant with billing practices.

For the items that are not covered in a FQHC (like in office procedures), can the group have a separate EIN and bill the services in the other group if seen separately from the FQHC visit (like another day)? I would think not, but have to ask since I can't find the yes or no definitively on that.

For Medicare with a commercial secondary, do they send the FQHC G code and regular coding to the secondary payer or just the normal procedure codes?

Thank you for your assistance!

 

[cdnred1360]

A FQHC can bill for both a medical E/M visit and a mental health visit on the same day (like G0467 and G0470, this is an exception. For items that are not covered in a FQHC like office procedures-these are non-billable and not a qualifying visit, you must report/record them where services were actually performed and on date they were performed for compliance. write off as non-billable G is typically done by most FQHCs. Most procedures in office include e/m as an integral part of the procedure (see surgical guidelines) so a separate e/m would not be reported unless a significant/separate problem is addressed and meets criteria for an e/m that would stand alone.