FQHC and RHC billing runs on rules that generalist billers rarely see: PPS encounter rates, Medicare all-inclusive rates, wraparound claims, and sliding-fee accounting. Miss a billable encounter, skip a wraparound cycle, or map a visit to the wrong G code and reimbursement quietly falls below cost. RCMGen's FQHC and RHC billing services are built for HRSA-funded health centers and rural clinics that cannot afford leakage.
Our teams bill PPS and AIR claims daily under current CMS FQHC rules and state Medicaid plans, coordinate wraparound with managed Medicaid, and run the same eligibility, coding, and follow-up discipline as our clinic and physician group RCM practice, adapted to encounter-based payment.
Encounter-based payment changes what "clean claim" means: the revenue question is whether every qualifying visit became a billable encounter at the right rate. Our teams reconcile schedules to encounters daily through our medical billing workflow, verify coverage through eligibility verification, and chase every underpaid encounter like the contract violation it is.
PPS encounter-rate billing
FQHC encounters billed at your PPS rate with qualifying-visit rules applied, so no eligible encounter bills as fee-for-service by mistake.
Medicare AIR claims (RHC)
Rural health clinic claims billed under the all-inclusive rate with correct revenue codes and preventive carve-outs.
Medicaid wraparound billing
Wraparound and reconciliation claims filed monthly against managed care payments, capturing the difference you are owed.
Sliding fee schedule accounts
Discount schedules applied consistently, documented for HRSA compliance, and reflected accurately in patient statements.
G-code and revenue code mapping
Visit types mapped to correct G codes and revenue codes, reviewed whenever CMS updates FQHC billing guidance.
Behavioral health integration billing
Mental health encounters, same-day medical and behavioral visits, and integration codes billed under FQHC-specific rules.
Community health billing, in numbers
Community health workflows we run daily
Community health centers juggle grant compliance, managed Medicaid churn, and thin margins at once. These six standing workflows keep the revenue side steady, coordinated with credentialing and A/R follow-up so every function sees the same encounter truth.
Care management billing (CCM, BHI)
Chronic care and behavioral health integration programs billed monthly with time and consent documentation tracked.
Telehealth for FQHC and RHC
Virtual encounters billed under current FQHC and RHC telehealth rules, which change often and pay differently.
Managed Medicaid follow-up
MCO claims statused and escalated on plan-specific cadences, feeding wraparound reconciliation with clean data.
Encounter capture audits
Daily schedule-to-encounter reconciliation, so walk-ins, nurse visits, and same-day add-ons never go unbilled.
Cost report data support
Visit counts, payer mix, and revenue detail organized so your cost report preparer starts from clean numbers.
UDS-aligned reporting
Billing data structured to support UDS tables, saving your team the year-end reconstruction scramble.
Why community health centers choose RCMGen
We built our practice around underserved-market providers: critical access hospitals, rural health clinics, and FQHCs, the same markets covered in Community hospital billing: how U.S. hospitals get paid in 2026. Delivery is led by senior specialists with clinical leadership from Dr. Eduardo de la Torre and operations leadership including Elango Madhavan, and Medicaid disruptions like the 2026 California deferral are monitored as operational risks, not news items.
Health centers run on grant-audited budgets, so our terms are plain: transparent pricing, performance commitments in writing, 3-day onboarding, and $0 setup fees. Related hospital-side needs, including swing-bed and critical access hospital RCM, run under the same roof. Start with a free instant revenue audit or reach us through contact.