HCA limits encounters to one per client, per day, except in the following circumstances:
- There is a subsequent visit in the same cost center (e.g., medical, dental, SUD, etc.) that requires separate evaluation and treatment on the same day for unrelated diagnoses; or
- There are separate visits in different types of cost centers that occur with different health care professionals. (For example, a client with a separate medical and dental visit on the same day.)
All services provided within the same cost center, performed on the same day, must be included in the same encounter, except in the circumstances outlined above.
All FQHC services and supplies incidental to the provider’s services are included in the encounter rate payment.
FQHCs must provide services in a single encounter that are typically rendered in a single visit based on clinical guidance and standards of care.
Each encounter must be billed on a separate claim form. On each claim, to indicate that it is a separate encounter, enter “unrelated diagnosis,” the time of both visits in the Claim Note section, and the appropriate modifier for the service provided.
When billing two different claims for the same date of service, a modifier must be entered on at least one of the claims. The same modifier cannot be used on the first and second claim. HCA must fully process the first claim before the provider submits the second.
Documentation for all encounters must be kept in the client’s file.
Maternity Support Services (MSS)
HCA allows more than one Maternity Support Services (MSS) encounter, per day, per client, if they are:
- Different types of services
- Performed by different practitioners with different specialties
- Billed on separate claim forms
When billing for more than one MSS encounter for the same date of service and client, use modifier XP with the HCPCS procedure code T1015 on the second claim.
Only one encounter per day at a dental clinic is covered. Exception: When a dental service requires multiple visits (e.g., root canals, crowns, dentures), an encounter code must be billed with the number of visits when the dental services are complete.
SOURCE: WA HCA Provider Guide, Federally Qualified Health Centers, p. 20, 22, 30, 31, 64 (Oct. 2023). (Accessed Dec 2023).