Are you new to RHCs/FQHCs?

Gainwell Technologies are important to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) because they often serve as the Medicaid claims processor for certain states, ensuring proper payment of services, including wrap payments.

As the fiscal agent, Gainwell is responsible for ensuring accurate and timely payment to providers and processing provider claim disputes and appeals.

Key Reasons Gainwell Matters to RHCs and FQHCs:

1. Medicaid Claims Processing & Payments
   • Gainwell serves as the Medicaid fiscal agent in multiple states, processing fee-for-service (FFS) claims for RHCs and FQHCs.
   • Ensures timely and accurate reimbursement for Medicaid-covered services.
2. Wrap Payment Processing
   • Manages wraparound payments for RHCs and FQHCs to ensure they receive full reimbursement under the Prospective Payment System (PPS).
   • Identifies and reprocesses claims when system errors impact payments.
3. Provider Enrollment & Credentialing Support
   • Assists RHCs and FQHCs with Medicaid enrollment and credentialing to ensure providers are properly registered.
4. Claims Adjustments & System Updates
   • Implements changes to billing codes, reimbursement policies, and encounter logic that affect how RHCs and FQHCs bill for services.
   • Supports providers when updates (e.g., new encounter codes) impact claims processing.
5. Medicaid Managed Care & Fee-for-Service (FFS) Coordination
   • Works with Managed Care Organizations (MCOs) and state Medicaid agencies to ensure seamless claims submission and payment reconciliation.
6. Technical Support & Provider Assistance
   • Offers help desk services for billing issues, claims denials, and policy questions.
   • Provides training on Medicaid claims submission and reimbursement policies.

Gainwell Provider Portal: Varies by State through their Medicaid Portals

Myers and Stauffer are important to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) because they serve as third-party auditors and consultants for Medicaid programs, helping states ensure compliance with federal and state regulations. They play a key role in cost reporting, reimbursement rate setting, and program integrity for RHCs and FQHCs.

Key Reasons Myers and Stauffer Matter to RHCs and FQHCs:

1. Medicaid Cost Reporting & Reimbursement:
   • Myers and Stauffer assist states in establishing Medicaid reimbursement rates for RHCs and FQHCs based on cost reports.
   • They ensure Prospective Payment System (PPS) rates and alternative payment methodologies (APMs) are calculated accurately.
2. Annual Encounter Code Listings & Updates:
   • They maintain and update valid encounter code lists for RHCs and FQHCs, ensuring providers use appropriate billing codes for Medicaid reimbursement.
   • Updates to encounter codes (such as removals or additions) are often published on their website.
3. Medicaid Program Audits & Compliance:
   • Myers and Stauffer conduct audits to verify that RHCs and FQHCs comply with Medicaid regulations and billing guidelines.
   • Their audits help prevent fraud, waste, and abuse while ensuring providers receive accurate payments.
4. 340B Program Compliance & Support:
   • They assist in auditing and monitoring 340B drug pricing program compliance, ensuring that RHCs and FQHCs meet eligibility requirements and properly document drug purchases and usage.
5. Technical Assistance & Policy Guidance:
   • They provide training and resources for RHCs and FQHCs to navigate changes in Medicaid policy, reimbursement methodologies, and cost reporting requirements.

Myers and Stauffer Website: https://www.myersandstauffer.com