The health care complexity can make operating physician practices IN regular terms at times of challenge. Later, add additional requirements, rules, and government regulations. As a result, you have a billing nightmare identified as an FQHC or RHC.
For the big money, many physicians have considered opening FQHC or RHC. But before you go for opening an FQHC or RHC, it is important to understand what they mean. So, in this article, the main focus is on differentiating FQHC and RHC.
FQHC vs RHC
The main difference between FQHC and RHC is that from the Centers for Medicare and Medicaid Services and the Bureau of Primary Health care of the United States DHHS, FQHC is a designation of reimbursement. On the other hand, RHC consists separate reimbursement structure in the United States from the standard medical office.
The abbreviation for Federally Qualified Health Center is FQHC. Approximately there is a total of 1,124 clinics of FQHC with each could have multiple sites which are spread across the US. The chief purpose of the FQHC program is to enhance the primary care services provided in unreserved rural and urban communities.
The abbreviation for Rural Health Center is RHC. Today, approximately 4,000 clinics of RHC are spread throughout the US. They are located in non-urbanized and underserved areas which are defined by the Census Bureau of US. They are responsible for submitting certain claims in a format of professional claims.
Comparison Table Between FQHC and RHC
|Parameters of Comparison||FQHC||RHC|
|Origin||In 1991||In 1977|
|Located||In both rural and urban areas||In rural areas|
|Governance||User majority board of directors required||No specific requirements|
|Corporate structure||Tax-exempt nonprofit or public||Public, profit, unincorporated, or non-profit|
|Clinical staffing||No specific requirements||MLP required time of at least 50% of the clinic is open|
What is FQHC?
FQHC is required to collect the total 20 percent of customary and usual charges when applicable by Medicare claims. They are required to offer for all life cycle ages primary care and do not employ any specialist like pediatric care. They are required to be corporations based on nonprofit.
By Congress, FQHC is created. It is to ensure that grant dollars are intended for the uninsured and available for that process by allowing particular Medicaid and Medicare payments. FQHC has certain services that can be separately billed by utilizing the modifiers appropriately.
FQHC must utilize a scale of sliding fee with available varying discounts based on the family size of the patient as well as income per guidelines of federal poverty. When the practice is closed, FQHC should offer professional coverage.
FQHC are required to have privileges of hospital admitting for the physician in the practice or document with a plan of hospital coverage that ensures care continuity. On-site they are required to offer preventive dental services or through other providers’ arrangements.
What is RHC?
RHC offers services of primary care through a team approach of nurse practitioners (NPs), physicians, certified nurse-midwives (CNM), and physician assistants (PAs). The clinics must employ at least one PA or NP to be classified as an RHC. For certain procedures, it gets one reimbursement rate regardless of provided service that is built on a claim of institutional.
However, other services and procedures are required to be separately billed on a professional claim during the same visit. The CNM, PA, or NP must work at the clinic at least the time 50 percent of the clinic operates. They have to furnish laboratory and diagnostic services while RHC is open as well as for emergencies treatment should have necessary available drugs.
The service is of RHC consists of patients’ residences, visit the clinics, Medicare-covered parts, assisted living facility, and a skilled nursing facility. Other services of RHC include outpatient and inpatient consults, these kinds of visits are referred to non-RHC services as well as billed separately.
RHC receives a cost-based reimbursement for core physicians’ defined set and certain services of non-physician outpatient. These payments are generally based on the methodology of all-inclusive payment and maximum payment per visits sub and annual reconciliation referenced as encounter rate.
Main Differences Between FQHC and RHC
- Under the jurisdiction of FQHC, it is necessary to provide health care services for every member. In contrast, in the community, RHC is not required to offer people healthcare-related services.
- When it comes to malpractice insurance, under the Federal Tort Claims Act the FQHC can get the money through federal funding. On the other hand, RHC themselves offer the insurance.
- FHQC is generally under a federal objective review. On the flip side, RHC is under the CMS or simply Centers for Medicare and Medicaid service.
- FQHC offers broader services related to health care in comparison to RHC. FQHC services are made by appointment. On contrary, RHC only offers basic lab services, primary outpatient care, and emergency care.
- FQHC is a reimbursement designation from the Centers for Medicare and Medicaid Services and the Bureau of Primary Health care of the united state’s DHHS. Meanwhile, RHC has a separate reimbursement structure in the United States from the standard medical office.
It can be concluded that both FQHC and RHC have been considered to be open by several physicians, particularly for the big money. The roots of the FQHC origin can be traced to 1991, whereas the origin of RHC can be traced to 1977. FQHC is generally located in both rural and urban areas, while RHC is only located in rural areas.
For the governance of FQHC, there is a user majority board of directors required. In contrast, there are no specific requirements of governance in RHC. When it comes to corporate structure, FQHC has tax-exempt nonprofit or public. On contrary, public, profit, unincorporated, or non-profit is the structure in RHC. There are no specific requirements for clinical staffing in FQHC. Meanwhile, MLP required time of at least 50% of the clinic is open in RHC.
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