MEDICARE PPS
What You Need to Know About the New FQHC PPS
The FQHC PPS Transition
On May 2, 2014, The CMS finalized a new Medicare prospective payment system (PPS) for FQHCs, as mandated by the Affordable Care Act. Per requirements set forth, health centers began to transition to the new Medicare PPS rate on October 1, 2014. To view your FQHC's implementation date, click here.Have you considered these factors for the implementation process?
- If you implement the new Medicare PPS rule correctly, your health center stands to increase its revenue substantially.
- If you implement incorrectly, you risk not only leaving money on the table, but also scrutiny from CMS for setting your rates too high (or too low).
- This rule has significant impact on your grant – particularly as to how your sliding fee scale is applied to patients. All Health Centers must understand and prepare for these changes.
There is One National PPS Rate for All FQHCs
Medicare will pay FQHCs a single encounter-based rate per beneficiary per day. The rate is $158.85, through December 31, 2015, with some adjustments. Each FQHC’s rate is adjusted based on the location of where the services are furnished. FQHCs will be paid based on the lesser of the adjusted PPS rate or their charges. The rate will be updated annually to reflect inflation. The new rate will begin on January 1 of each year, starting January 1, 2016. (Information was retrieved from CMS.gov)Trainings in January Regarding Medicare PPS:
- January 14 - Medicare FQHC PPS Training presented by Blue & Co. in Westerville, OH
- January 14 - Medicare PPS ONE-DAY Implementation Training presented by NACHC and BKD, LLP in Atlanta, GA
- January 15 - Medicare PPS ONE-DAY Implementation Training presented by NACHC and BKD, LLP in Atlanta, GA
More Information
You can get useful information from CMS on the new FQHC PPS HERE and HERE.For FAQs on the matter click here
View the "New Medicare PPS for FQHCs" Presentation by the Medicare Learning Network HERE
To view important factors to consider about the implementation process and a recording of NACHC's Medicare PPS Webinar click here.
