2006 proposed fee schedule - American Society of Clinical Oncology

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Effective January 1, 2006, eligible FQHCs will report
actual revenue received from the MA plan and visits on their
cost reports. At the end of the cost reporting period the
FI would use actual MA revenue and visit data along with
the FQHCs’ final all-inclusive payment rate, to determine
the center’s final actual supplemental per visit payment for
enrollees in the relevant MA plan. This will serve as the
interim rate for the subsequent rate year. Actual aggregated
supplemental payments will then be reconciled with
aggregated interim supplemental payments, and any
underpayment or overpayment thereon will then be accounted
for in determining final Medicare FQHC program liability at
cost settlement. Necessary changes will be made to the FQHC
cost report to effectuate the calculation of the
supplemental rate.
A supplemental payment will be made every time a face-
to-face encounter occurs between a MA enrollee and any one
of the following FQHC covered core practitioners:
physicians, NPs, PAs, clinical nurse midwives, clinical
psychologists, or clinical social workers. The supplemental
payment is made directly to each qualified center through
the Medicare FI. Each center is responsible for submitting
Medicare claims with the proper codes for these visits.
Necessary changes will be made to the instructions for the