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Printed Date: 9/22/2015
If you are designated by Medicare as a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and perform services that are outside the scope of the FQHC or RHC, it is the responsibility of the clinic to ensure that the service is submitted to the correct Medicare Administrative Contractor, i.e. either Part A or Part B.
Monitoring is in place for Medicare Part B to ensure that services are not paid by both A and B. Clinic services submitted to Part B that should be included in the All Inclusive Rate (AIR) or those that are considered a FQHC or RHC benefit will be denied.
Only Independent FQHCs or RHCs should be submitting services to Medicare Part B for non-clinic services. Please follow CMS Internet Only Manual instructions found in the Benefit Policy Manual, 100-2, Chapter 13 (PDF, 282 KB) and the Claims Processing Manual, 100-4, Chapter 9 (PDF, 241 KB) to ensure proper billing.
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Last Updated: 03/25/2020