Same-day billing for medical and mental health services at FQHCs: estimating the fiscal impact
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Degenfelder, Curt, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, California] : California Health Care Foundation, April 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Mental Health Services -- economics Prospective Payment System United States
- Genre(s):
- Technical Report
- Abstract:
- This issue brief provides an analysis of the fiscal impact in California of same-day billing for medical and mental health services in Federally Qualified Health Centers (FQHCs). FQHCs are paid by Medi-Cal under the Prospective Payment System (PPS). In California, each licensed clinical site (clinic site) has its own PPS rate, with a fixed per-visit dollar amount payment rate for qualifying visits. These rates are increased by the Medicare Economic Index (MEI) each year. FQHCs may also apply for a rate change through the Medi-Cal Change in Scope-of- Service Request process. Currently, while FQHCs may render both medical and mental health services on the same day to Medi-Cal patients, they cannot be reimbursed for both visits. California has considered several proposals to allow FQHCs to bill a medical visit and a mental health visit that take place on the same day at a single location as separate visits, referred to as "same-day billing." The analysis that follows estimates the impact of a policy change to allow same-day billing both without (Scenario 1) and with (Scenario 2) a requirement that FQHCs apply for a change in scope in order to have the option of billing for same-day visits for mental health. The analysis is not specific to a particular current or past proposal. The analysis provides an estimate of the annual impact of the two scenarios on both Medi-Cal mental health visits and Medi-Cal reimbursement costs.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (5 pages)).
- NLM Unique ID:
- 101771813 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101771813