G-Code Breakers for FQHCs: Does your EHR qualify?
- By Shah Rook Shameem
- Apr 24 , 2019
G-codes is a term that would confuse most people. However if you are an experienced medical biller you would know that these codes are a critical part of the revenue cycle. Those RCM specialists involved in the functioning of Federally Qualified Health Centers (FQHCs) would tell you that the PPS G-codes add an extra element of complexity to billing and compliance that is beyond what a normal practice would have to endure.
What are G-Codes?
G-Codes are payment-specific codes that FQHCs need to present on UB-04 claims so their funder can recognize the services provided.. The majority of EHR systems are designed to generate service codes, but G-Codes are unique, because they are generated based on a combination of different criteria. This adds an element of complexity that RCM components of most EHR systems were not and are not designed to address. To compound these issues, UB04 claim formats, typically associated with inpatient services, are not something that outpatient EHR applications typically deal with either.
G0466 — A medically-necessary, face to face encounter (one-on-one) between a new patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a FQHC visit.
G0467 — A medically-necessary, face to face encounter (one-on-one) between an established patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a FQHC visit
G0468 — A FQHC visit that includes an Initial Preventive Physical Examination (IPPE) or Annual Wellness Visit (AWV) and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV.
G0469 — A medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare covered services that would be furnished per diem to a patient receiving a mental health visit.
G0470 — A medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare covered services that would be furnished per diem to a patient receiving a mental health visit.
Each specific payment code must be submitted with a qualifying visit on a separate line. The use of these specific payment codes, and the crosswalk to the corresponding line item HCPCS code, may be subject to the following conditions, which are flagged by number in the following tables:
A billing guide to FQHCs can be viewed in this link.
BlueEHR recognizes the specific FQHC billing and reporting requirements that must be met in order to submit claims and receive reimbursements from all sources. The FQHC Mapping System
Functionality within blueEHR is an excellent training tool. The feature works as follows : when a physician or coder enters a medical keyword or HCPCS codes, a side-by-side lookup feature will display the relevant FQHC code. It also shows the qualifying visit that corresponds to the specific payment and the relevant FQHC codes that healthcare professionals can compare before submission.
With the ability to identify appropriate combinations of criteria, blueEHR acts like a code-breaker in many ways, generating the key necessary to get paid. Based on a flexible and modern software architecture, blueEHR is often used to address unique healthcare challenges. So, it’s no surprise that it could bring in mixed components of functionality to create a seamless end-to-end FQHC solution.
Bringing together scheduling, integrated care clinical documentation, G-codes, sliding fee scales and federal reporting, all in one place, is what makes blueEHR the EHR that FQHCs can lean on.
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