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Federally qualified health centers may see pay increase
e-Reports, June 2, 2014
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CMS seeks comments on chronic care services for rural clinics Untitled document

A new rule issued by the Centers for Medicare & Medicaid Services (CMS) implements a payment system that may increase Medicare payments to Federally Qualified Health Centers (FQHC) by as much as 32 percent.

Established by the Affordable Care Act, the Prospective Payment System (PPS) will begin Oct. 1, 2014, with FQHCs transitioning though 2015. The system will be based on factors such as type, intensity and duration of services provided.

“The new payment system helps increase the ability and capacity of federally qualified health centers to provide essential and affordable services for even more patients who need care,” said CMS Administrator Marilyn Tavenner. “These FQHCs are essential to countless patients in local communities who depend on them for getting their primary and preventive care.”

Under the PPS, Medicare will pay the health centers a single encounter rate per beneficiary per day for all services provided, with some exceptions. Rates will be adjusted for geographic variation in costs, care to a patient that is new to the FQHC, and an initial preventive physical examination or annual wellness visit for a Medicare beneficiary.

While the final rule was published in the May 2 Federal Register, CMS is seeking final comments on modifications of a few proposals including:

  • A simplified method for calculating co-insurance for a preventive and non-preventive service on the same claim
  • The establishment of Medicare-specific payment codes to be used for Medicare encounter-based payment under the new PPS
  • Ways in which payment for chronic care management services could be adapted for FQHCs and rural health clinics

CMS will accept comments until July 1, 2014, and will respond to them in a final rule later in 2014.

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