Cost Based, All-Inclusive Cost Based, Medicare Reimbursement Fee for Service N/A Rate Per Visit Rate Per Visit State-specific Medicaid Reimbursement State-specific State-specific (Typically Fee for N/A Service) Varies by Health Plan Varies by Health Plan Varies by Health Commercial Insurance (Typically Fee for (Typically Fee for Plan (Typically Fee N/A Service) Service) for Service) Sliding Fee Scale Required No Yes No No Federal Funds to Offset Cost of Uncompensated No Yes No No Care Application to HRSA RHC application to state Bureau of Primary Initial Application Process SA & 855A enrollment Health Care & 855A N/A N/A application to CMS enrollment application to CMS Recertification Annual Not required N/A N/A Yes Yes (and UDS) No No Annual Evaluation Access to Federal Tort No Yes No Yes Claims Act (FTCA) medical malpractice protection Medicare Cost Report Yes Yes No No Required Practitioner Productivity Yes Yes N/A N/A Standard
Medicare Reimbursement Cost Based, All-Inclusive Rate Per Visit Cost Based, Rate Per Visit Fee for Service N/A Medicaid Reimbursement State-specific State-specific State-specific (Typically Fee for Service) N/A Commercial Insurance Varies by Health Plan (Typically Fee for Service) Varies by Health Plan (Typically Fee for Service) Varies by Health Plan (Typically Fee for Service) N/A Sliding Fee Scale Required No Yes No No Federal Funds to Offset Cost of Uncompensated Care No Yes No No Initial Application Process RHC application to state SA & 855A enrollment application to CMS Application to HRSA Bureau of Primary Health Care & 855A enrollment application to CMS N/A N/A Recertification Annual Not required N/A N/A Annual Evaluation Yes Yes (and UDS) No No Access to Federal Tort Claims Act (FTCA) medical malpractice protection No Yes No Yes Medicare Cost Report Required Yes Yes No No Practitioner Productivity Standard Yes Yes N/A N/A
RHC-FQHC%20Facility%20Comparison.docx