Clinic Reimbursement & Oversight
Federally qualified health centers (FQHCs), rural health clinics (RHCs), and community mental health centers (CMHCs) play a vital role in expanding access to primary care and behavioral health services for Medicaid beneficiaries. Myers & Stauffer helps state Medicaid agencies develop and oversee reimbursement methodologies, financial oversight activities, compliance initiatives, and provider payment programs, including specialized support for FQHC and RHC prospective payment systems (PPS) and managed care wrap payments. Our independent, government-focused expertise helps agencies strengthen reimbursement accuracy, regulatory compliance, and long-term program sustainability.
Supporting FQHC & RHC Reimbursement & Oversight
Federally qualified health centers (FQHCs), rural health clinics (RHCs), and community mental health centers (CMHCs) play important roles in Medicaid programs by expanding access to primary care, preventive services, and behavioral health care, particularly in underserved and rural communities.
While FQHCs, RHCs, and CMHCs operate under different reimbursement and regulatory frameworks, each requires specialized oversight, reimbursement expertise, and a thorough understanding of provider operations.
Myers & Stauffer supports government agencies in designing, implementing, and overseeing reimbursement, compliance, and financial oversight programs for clinic-based providers across Medicaid.
How We Support Clinics
While much of our work focuses on FQHC and RHC prospective payment systems, we also support Medicaid agencies with reimbursement analysis, financial oversight, and policy initiatives affecting other clinic-based providers, including CMHCs.
We assist Medicaid agencies in developing and maintaining PPS rates for FQHCs and RHCs in accordance with federal requirements.
Our services include:
Our experience helps ensure that PPS rates are developed consistently and supported by appropriate documentation.
Auditing provider cost reports and financial data is a key component of reimbursement oversight for clinic-based providers, including FQHCs, RHCs, and other provider types as applicable.
We support agencies through:
This work helps agencies maintain
accurate and defensible reimbursement processes.
As states expand managed care, ensuring accurate and timely wrap payments to FQHCs and RHCs is critical.
Our services include:
We help agencies align managed care payment structures with federal requirements for FQHC and RHC reimbursement.
We assist agencies in maintaining compliance with federal and state requirements related to clinic reimbursement and provider compliance.
Our work includes:
We provide data-driven insight to support policy decisions affecting clinic-based providers across Medicaid programs.
Our services include:
Informed by Provider Experience
Our work with FQHCs and RHCs is informed by a broader understanding of provider operations and reimbursement across care settings.
Connect With Our Team
Partner with experts who understand the complexities of health and human services programs. Let us guide your organization through the industry’s unique challenges and opportunities.
Tim Guerrant, CPA
Member
Email: tguerrant@mslc.com
Phone Number: 317-815-2935
In the Words of our Clients…
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