Our Services — Revenue Cycle Management

FQHC Billing Services

01 — Specialized FQHC Expertise

Revenue Cycle for Community Health

Specialized RCM services designed for the unique billing requirements of Federally Qualified Health Centers.

FQHCs and Look-Alike centers operate under unique Medicare and Medicaid prospective payment systems (PPS) that require specialized expertise. CIAxil’s FQHC billing team understands the complexities of encounter-based billing, sliding fee scales, and the documentation requirements specific to community health centers.

“FQHCs serve the most vulnerable communities — they deserve a billing partner who understands every nuance of their unique payment model.”

We help FQHCs maximize their PPS reimbursement, ensure scope-of-service compliance, and manage the complex reporting requirements tied to federal grant funding and HRSA oversight.

FQHC-Specific Billing Expertise

From PPS encounter billing to sliding fee schedule management, we handle every aspect of FQHC revenue cycle.

FQHC Services

What We Provide

  • Prospective Payment System (PPS) Billing: Medicare & Medicaid encounter billing.
  • Sliding Fee Schedule Management: Discount application and audit compliance.
  • Scope of Service Compliance: Ensuring all billed services fall within approved scope.
  • Wraparound Payment Reconciliation: Medicaid managed care supplement tracking.
  • HRSA Reporting Support: UDS data preparation and grant compliance.
  • Enabling Services Billing: Transportation, translation, and case management coding.
  • Grant Fund Reconciliation: Coordination between billing revenue and grant income.
02 — Compliance & Reporting

HRSA & Regulatory Compliance

Keeping your FQHC compliant with federal requirements while optimizing revenue capture.

Maintaining FQHC designation requires rigorous compliance with HRSA program requirements, including accurate Uniform Data System (UDS) reporting, 330 grant compliance, and ongoing documentation of governance and governance structure. CIAxil helps you navigate these requirements while keeping your revenue cycle performing at its best.

  • Annual UDS report preparation and data validation support.
  • Cost report preparation for Medicare FQHC cost reports.
  • 340B program compliance coordination with your pharmacy benefit.
  • Site visit preparation for HRSA operational site reviews.
Payer Expertise

FQHC Payer Mix

  • Medicare Part B: FQHC PPS encounter billing and reconciliation.
  • Medicaid Fee-for-Service: State-specific encounter rate billing.
  • Medicaid Managed Care: Wraparound payment tracking and appeals.
  • CHIP Programs: Children’s health coverage billing optimization.
  • Commercial Insurance: Standard fee-for-service billing for insured patients.
  • Uninsured / Sliding Fee: Compliant self-pay discount application.