Successful FQHC billing requires coordination between coding, documentation, payer requirements, claims processing, denial management, and AR follow-up. Reviewing of the billing process flows on a regular basis and being prepared for changes such as the telehealth coding update coming in October 2026 can be helpful for health centers to maintain consistency in the process.
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3 Areas FQHCs Should Focus on to Improve Billing Accuracy
Preparing for the 2026 Telehealth Billing Update
Telehealth billing is an important area for FQHCs to review in 2026. According to the Centers for Medicare & Medicaid Services (CMS), for dates of service on or after October 1, 2026, FQHCs must report the individual CPT or HCPCS code describing the distant-site telehealth service instead of using HCPCS code G2025. Claims must include the appropriate revenue code and one of the applicable telehealth modifiers:
Modifier 93: Synchronous telehealth delivered through audio-only technology.
Modifier 95: Synchronous telehealth delivered through real-time audio-video technology.
Managing Denials and Outstanding Accounts Receivable
Claim denials and payment delays can affect an FQHC's cash flow and increase administrative work. Common issues may involve missing information, eligibility discrepancies, coding errors, or payer-specific requirements. A structured denial management process should identify the reason for each denial, determine the necessary correction, and track the claim through resolution. Regular accounts receivable (AR) reviews are equally important. Aging reports help billing teams prioritize outstanding claims, follow up with payers, and identify recurring payment issues.
Monitoring Billing Performance
FQHCs can use regular reports to evaluate their revenue cycle and identify areas for improvement. Useful indicators include:
- Claim rejection and denial trends
- First-pass claim acceptance
- AR aging
- Payment posting accuracy
- Outstanding claim status
- Collection performance
Reviewing these metrics helps management understand where delays occur and whether billing workflows require additional attention.
e-care india offers FQHC medical billing solutions including coding, claims submission, payment posting, denials management, and accounts receivables assistance. This is done to assist healthcare organizations to effectively manage their FQHC billing process flows.
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