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If you are currently billing to Medicaid or Medicare, you are likely familiar with the Prospective Payment System (PPS) outlined by the Centers for Medicare and Medicaid Services (CMS). For Federally Qualified Health Centers (FQHC) or those looking to get Health Center designation, PPS rates are updated yearly and the system is changed more frequently than for other users. CMS established this form of payment to address expensive hospital care and to tame increasing rates, protecting vulnerable patients.

The passage of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA) in 2000 put in place PPS for FQHCs. Beginning in October of 2014, FQHCs started transitioning to a PPS where Medicare payment is made based on a national rate and adjusted to the location where service is rendered. Rates are also increased when a patient visits your center for the first time. This means that if you are part of an FQHC with clinics spanning a large area, a new patient in one clinic might have a different Medicare rate in another clinic. Previously rates for Medicare (formerly called the All Inclusive Reimbursement Rate) were fixed at the same level across different health centers. With ever-changing requirements and rates, it is important to stay in tune with the most recent information.

Google Alerts are a helpful tool for keeping up with recent news relevant to CMS and FQHCs. If you are in need of help, your EHR team should be able to help link you with relevant information and keep your EHR up to date with the latest Federal and State updates and requirements for healthcare.
Helpful Resources:
Prospective Payment Systems – General Information FQHC PPS Information 2015 Update on the Implementation of the FQHC PPS in the States