FQHC vs RHC: Difference and Comparison

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 big money, many physicians have considered opening FQHC or RHC. But before opening an FQHC or RHC, it is important to understand what they mean. So, in this article, the main focus is differentiating FQHC and RHC. 

Key Takeaways

1. FQHCs (Federally Qualified Health Centers) primarily serve underserved populations, while RHCs (Rural Health Clinics) focus on rural communities.
2. FQHCs receive federal grants to support operations, whereas RHCs receive cost-based reimbursement from Medicare and Medicaid.
3. FQHCs offer comprehensive health services, including dental and mental health, while RHCs mainly provide primary care services.

FQHC vs RHC 

Federally Qualified Health Centers are non-profit healthcare facilities that receive funding from the federal government to provide healthcare services to underserved populations. RHCs provide primary healthcare services to underserved populations and must meet certain requirements to receive federal funding.

The abbreviation for Federally Qualified Health Center is FQHC. Approximately there are 1,124 clinics of FQHC, each having multiple sites 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 the US Census Bureau defines.

They are responsible for submitting certain claims in a format of professional claims. 

Comparison Table

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 20 per cent of customary and usual charges when applicable by Medicare claims. They must offer primary care for all life cycle ages and do not employ any specialists like pediatric care.

They are required to be corporations based on nonprofits.  

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 using the modifiers appropriately.  

FQHC must utilize a scale of sliding fees 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 (CNMs), 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 built on a claim of institutional.

However, other services and procedures must be separately billed on a professional claim during the same visit. The CNM, PA, or NP must work at the clinic for at least the time 50 per cent of the clinic operates.

They have to furnish laboratory and diagnostic services while RHC is open, and treatment should have necessary drugs for emergencies.  

The service of RHC consists of patients’ residences, clinic visits, 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 and 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 all-inclusive payment methodology and maximum payment per visits sub and annual reconciliation referenced as encounter rate. 

Main Differences Between FQHC and RHC 

1. 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.  
2. Regarding malpractice insurance, under the Federal Tort Claims Act, the FQHC can get the money through federal funding. On the other hand, RHC themselves offer insurance.  
3. FHQC is generally under a federal objective review. Conversely, RHC is under the CMS or Centers for Medicare and Medicaid Services.  
4. FQHC offers broader services related to health care in comparison to RHC. FQHC services are made by appointment. On the contrary, RHC only offers basic lab services, primary outpatient care, and emergency care.  
5. FQHC is a reimbursement designation from the Centers for Medicare and Medicaid Services and the Bureau of Primary Health Care of the United States DHHS. Meanwhile, RHC has a separate reimbursement structure in the United States from the standard medical office. 

References 

1. https://europepmc.org/article/med/10181466
2. https://ieeexplore.ieee.org/abstract/document/6730914/