Louisiana FQHC Reimbursement Watch

Billing Code Changes

• 🔥 CCM CPT Codes for 2026: Beginning January 1, 2026, FQHCs and RHCs must bill individual CCM codes 99490, 99439, 99491,...

CMS has extended the deadline for hospitals to complete the controversial Medicare drug cost survey, which has significant 340B implications.

Big step for rural LA healthcare: Gov. Landry's order establishes the Office of Rural Health Transformation and advisory council in LDH.

• Grow...

• Jan 1, 2026 change: FQHCs and RHCs must bill individual CCM codes at national non-facility PFS rates
• Affected codes: 99490, 99439, 99491, 99437, 99487, 99489
• Key for FQHC billing teams to update processes now

Practical guide for Louisiana FQHC billers:

• Understand QW modifier, CLIA regulations, and Medicare rules for waived lab tests
• Apply QW correctly to prevent claim denials

• Part D Redesign Finalized: Codifies IRA changes like OOP cap at $2,100, no coverage gap
• Risk Adjustment Reforms Ahead: RFIs highlight potential...

Billing and Denial Management

• 🔥 Denial Code 97: Denial code 97 occurs when a service is not paid separately because its cost is included in...

• Form selection: Use CMS-1500 for professional, UB-04 for institutional claims
• POS & TOB codes: Master these for proper claim submission
• Claim...

Louisiana FQHCs with MA contracts: Track these shifts for reimbursement and VBC impacts.

• 2.48% average increase to insurers, plus 2.5% risk...

Federal squeeze on provider taxes: H.R. 1 eliminates new/increased taxes, stricter waivers, reducing federal matching and saving $200B over...

Anthem policy shift impacts facility billing:

• No separate reimbursement for moderate sedation; bundled into procedure or facility fee
• Aligns with...

Key 2026 trends from HealthStream's report to optimize enrollment and cut revenue loss:

• Speed matters: Enrollment delays fragment workflows,...

Key strategies to prevent Denial Code 97 (service bundled into another paid procedure):

• Double-check codes pre-submission against payer bundling...

FQHC billing teams: CMS CRUSH anti-fraud plan sparks industry backlash.

Key risks highlighted:

• Burdensome admin requirements over enforcing...

Medical coding's 72,000 U.S. options dictate FQHC payments, claims, and stats—wrong picks mean rejected bills or bad diagnoses.

• Bizarre specificity...

FQHC finance teams: Home health's structural gaps mirror our reimbursement risks. Cash-basis accounting hides silent claim failures, eligibility...

FQHC diagnostic billing watch: Flawed PAMA implementation via skewed data triggers severe cuts.

• Smaller labs hit hardest by disproportionate impacts.
• 2026 deadline brings consolidation risks.
• Stifles innovation, threatens patient access.

Zero-tolerance enforcement ramps up: Trump Admin taskforce arrests 8, including nurses and psychologist, for $50M+ Medicare fraud via sham hospices...

Billing and Coding Updates

• 🔥 Injections Coding Article Revised: The Billing and Coding Article for Injections - Tendon, Ligament, Ganglion...

• CMS CRUSH RFI proposes regs to curb Medicare/Medicaid fraud via tighter enrollment ID, site visits, billing pattern scrutiny.
• National Alliance...