PPS, sliding-fee, UDS, 340B. The whole community-health stack.
Federally qualified health centers run on a different financial model than fee-for-service medicine. Wraparound payments, PPS rates, sliding-fee scales, UDS deadlines, and 340B obligations all interact. and miss any one of them and your federal compliance posture cracks.
340B, 501(r)
Six functions tuned for the FQHC payment model.
Generic RCM teams treat FQHCs like physician groups. They aren’t. PPS rate billing, wraparound capture, and sliding-fee administration are the difference between sustained operations and grant dependence.
PPS rate billing
Per-visit prospective payment, billed correctly to Medicare and Medicaid. Encounter qualification rules respected. Same-day-multi-encounter rules applied per state Medicaid manual.
Wraparound & reconciliation
MCO encounter data submitted on time. Wraparound (supplemental) payments reconciled quarterly to the PPS rate. Variance pursued, not absorbed.
Sliding-fee scale administration
HRSA-compliant sliding-fee design and administration. Family income verified, document trails maintained. Patient-pay portion sized to the schedule and explained in the patient’s language.
UDS reporting alignment
UDS data quality is the year’s most stressful three weeks. We align registration, coding, and patient demographics throughout the year so January isn’t a fire drill.
340B contract pharmacy & eligibility
Eligibility determination, contract-pharmacy reconciliation, and OPAIS posture. We work with your 340B program manager to keep the audit trail clean and the savings calculations defensible.
Grant & cost-report support
Section 330, MUA/MUP designations, and Medicare cost report (CMS-222) prep. Revenue, cost, and statistical data assembled cleanly so your finance team isn’t reverse-engineering a year of work in two weeks.
Six structural leak points.
Wraparound never claimed
MCO under-encounters, state wraparound never paid because it was never asked for.
Same-day rule mishandled
Medical + dental + behavioral same-day billed wrong for the state. One denial creates a pattern.
Sliding-fee documentation gap
Family income not verified at the encounter. Patient pay never collected, federal compliance at risk.
UDS January fire drill
Year of data quality issues surfaced in three weeks. Clinical, registration, and finance fight under deadline.
340B eligibility creep
Ineligibles included in 340B claims. Audit risk silent until HRSA arrives.
Cost-report scramble
Stat data and revenue data not tied year-round. CMS-222 reverse-engineered under deadline pressure.
Five phases. Same partner.
PPS & wraparound read
90 days of encounters reviewed for PPS qualification, wraparound capture, same-day discipline.
Sliding-fee & UDS
Sliding-fee documentation audit. UDS data-quality baseline established by service line.
Cutover
FQHC bench assigned. State Medicaid matrix loaded. Wraparound reconciliation cycle started.
First reconciliation
First quarterly wraparound reconciliation. Sliding-fee compliance check. UDS QA on track.
QBR + UDS prep
Senior partner walks scorecard. UDS readiness reviewed. 340B audit posture confirmed.
Six SLAs. FQHC-specific.
| METRIC | TARGET | WHY IT MATTERS |
|---|---|---|
| PPS encounter qualification | 99%+ | % of submitted encounters that meet HRSA face-to-face / scope criteria. Audit-defensible. |
| Wraparound recovery | Quarterly | MCO + state wraparound vs. PPS, reconciled per encounter. Variance pursued, not absorbed. |
| Sliding-fee documentation | 98%+ | % of self-pay encounters with HRSA-compliant income verification on file. |
| UDS data quality | Year-round | Monthly UDS-table QA across registration, coding, demographics. No January fire drills. |
| Days in AR (dollar-weighted) | 35-45 | FQHC-typical range. State-Medicaid mix-adjusted. |
| 340B audit readiness | Continuous | OPAIS-aligned eligibility data, contract-pharmacy reconciliation. Audit-ready, not panic-assembled. |
FQHC is a different financial model. Generic RCM doesn’t fit.
PPS, wraparound, sliding-fee, 340B, UDS, cost reports, Section 330. these aren’t edge cases, they’re the operating model. Our FQHC bench is dedicated, has 10+ years per senior, and reads HRSA PIN updates the day they post. Your federal compliance posture is the asset; we keep it intact.
Federal-compliance fluency, not generic billing.
- HRSA-fluent senior. reads PIN/PAL updates the day they post.
- Year-round UDS QA. no January scramble, no surprises in BPHC submission.
- Wraparound discipline. MCO + state reconciled quarterly, by encounter.
- Sliding-fee audit-ready. documentation collected at the encounter, not retroactively.
- 340B compliance. OPAIS-aligned, contract-pharmacy reconciled, ready for audit.
Four monthly outcomes.
Get a free wraparound + UDS read.
Send us last quarter’s wraparound reconciliation and your most recent UDS submission. We’ll send back a 4-page diagnostic on capture, qualification, and data-quality risk. No obligation.
Pick a slot. No SDR triage.
Talk to a senior ASP-RCM partner about your FQHC. 30 minutes. Bring your last UDS submission, your PPS wraparound reconciliation, or your sliding-fee mix questions. Built for 330-grant operators.
30 minutes with a senior partner.
Free. Same calendar a senior partner and directors live in. The next available slots are below.