Medical Billing · Nationwide
FQHC & Community Health Clinics Medical Billing Services
CMS Prospective Payment System (PPS) encounter rates, Medicaid wrap-around payment reconciliation, and same-day medical plus behavioral health billing.
Aethera Healthcare Solutions provides full-service medical billing and revenue cycle management to Federally Qualified Health Centers, Look-Alikes, and Rural Health Clinics across the United States. We handle coding, claims, payment posting, denial management, and A/R follow-up end to end — so your team can stay focused on patient care while your revenue cycle runs cleanly.
Typical fqhc & community health clinics CPT range we work: G0466–G0470, G0511, G0512, 0521 (UB-04), 0900 (Mental Health), 99213–99215.
Why fqhc & community health clinics billing leaks revenue
Unbilled same-day behavioral health encounters: Payers improperly bundling mental health services (G0469/G0470) into medical encounters (G0466/G0467) when patients see both providers on the same date
Delayed Medicaid wrap-around reconciliations: State Medicaid managed care plans withholding supplemental interim payments and complex cost report true-ups
Sliding Fee Discount Schedule (SFDS) co-pay leakage: Inconsistent patient nominal fee collection and non-compliant poverty guideline tier verification
Chronic Care Management (G0511) and BHI (G0512) revenue loss: Failure to capture Medicare care coordination revenue across rural and underserved patient cohorts
How Aethera fixes it
Specialty-trained coders (CPC/CCS) code to the documentation
First-pass claim scrubbing against payer and NCCI edits
Proactive denial prevention and 72-hour denial work
Relentless A/R follow-up to drive days-in-A/R down
Eligibility and prior-auth verification before service
Transparent, real-time reporting in the provider portal
Free tools for your billing team
Use these any time — no login required.
FQHC & Community Health Clinics billing FAQ
How do you bill both a medical and mental health visit for the same patient on the same day?
Under CMS PPS guidelines, an FQHC can bill two separate PPS encounter codes (e.g. G0467 for medical and G0470 for mental health) on the same date of service using Modifier 59 or XE and separate revenue lines (0521 and 0900), provided both visits meet independent medical necessity criteria.
How does Aethera manage Medicaid PPS wrap-around reconciliations?
We track every Medicaid MCO claim adjudication against your state-approved PPS rate, automatically calculating the supplemental wrap-around differential and submitting electronic wrap logs to state Medicaid agencies for accelerated reimbursement.