Validated G-Codes

Automated FPG Adjustments

Audit-Trail Reconciled

Supplemental Payments Reclaimed

FQHC billing is fundamentally different from standard fee-for-service RCM. Claims must be submitted using specific G-codes to trigger the correct Medicare Prospective Payment System (PPS) rate or state-specific Alternative Payment Methodology (APM) rate. Our certified FQHC coders ensure absolute precision in encounter capture:

We actively audit schedules to ensure new patients (or those with an Initial Preventive Physical Exam) are billed with G0466, capturing the higher base rate, while established patients are properly coded with G0467.

We capture concurrent revenue for behavioral health services by properly appending G0470 when psychiatric care is delivered on the same day as a medical visit, ensuring you receive your full eligible reimbursement without unbundling denials.

We ensure your baseline rate correctly incorporates your specific Geographic Adjustment Factor (GAF) before claims are submitted to the clearinghouse.

Your Section 330 Grant depends entirely on the compliant administration of your Sliding Fee Discount Program (SFDP). During an Operational Site Visit (OSV), HRSA auditors will strictly scrutinize how you apply discounts based on the Federal Poverty Guidelines (FPG).

Revix MD removes the manual guesswork from your front desk. We automate your sliding fee scale logic within your Practice Management (PM) system. 

• We ensure that nominal fees are collected correctly, patient income verification dates are tracked rigidly, and sliding fee adjustments are posted to the ledger with exact, auditable transaction codes.     
• If HRSA audits your facility tomorrow, your financial data will perfectly mirror your approved board policies.

When an FQHC treats a patient covered by a Medicaid Managed Care Organization (MCO), the MCO rarely pays the full encounter rate. State Medicaid agencies are legally required to pay a supplemental “wrap-around” payment to cover the difference between the MCO reimbursement and your guaranteed PPS rate.

However, tracking these fractional payments manually is a primary source of revenue leakage for health centers. We aggressively pursue these funds. Using a specialized shadow-billing ledger, our RPA (Robotic Process Automation) bots reconcile every single MCO-adjudicated claim against your state’s exact PPS rate. We batch and file wrap-around claims automatically, reducing your recovery timeline from 90 days to 1 week to 15 days and flooding your center with previously abandoned cash flow.

The 340B drug pricing program provides critical margins for community health centers, but it introduces massive compliance risks regarding duplicate discounts. Federal law strictly prohibits a manufacturer from providing a 340B discount and a Medicaid rebate on the same drug.

We manage the complex billing interactions between your contract pharmacy program and your FQHC status. Our clearinghouse engines are programmed to automatically append the correct modifiers (such as Modifier UD or JG) to identify drugs acquired through the HRSA 340B Drug Pricing Program on Medicaid claims. We protect your “covered entity” status by ensuring absolute compliance with Medicaid carve-in/carve-out rules and GPO prohibitions.

Your annual Uniform Data System (UDS) reporting dictates your future federal funding. Manual data aggregation at the end of the year results in corrupted data and stressed administrative staff. Revix MD builds UDS compliance directly into your daily revenue cycle.

We map all financial data, encounter codes, and demographic inputs cleanly throughout the year, ensuring your data is instantly ready for HRSA submission by the February 15th deadline.

We train your providers to document patient complexity using specific Z-codes (e.g., Z59.0 for homelessness, Z59.4 for food insecurity). Accurately capturing SDOH not only justifies higher clinical complexity and protects your center during audits, but it provides the hard data required to win specialized grant allocations.