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Last Modified: 11/21/2017 Location: FL, PR, USVI Business: Part A
Update to the federally qualified health center (FQHC) prospective payment system (PPS) for calendar year (CY) 2018 - recurring file update
Effective date: January 1, 2018
Implementation date: January 2, 2018


Change request (CR) 10334 informs Medicare administrative contractors (MACs) that, effective January 1, 2018, the following items apply to FQHC claims:
1. Beginning in 2017, the FQHC PPS rate is updated annually by the FQHC market basket. Based on historical data through second quarter 2017, the FQHC market basket for CY 2018 is 1.9 percent. From January 1, 2018, through December 31, 2018, the FQHC PPS base payment rate is $166.60. The 2018 base payment rate reflects a 1.9 percent increase above the 2016 base payment rate of $163.49.
2. The PRICER update, effective for January 1, 2018, also corrects the geographic adjustment factor (GAF) for carrier/locality 0118272 (San Diego-Carlsbad, CA) to be 1.054 for CY 2017.
3. MACs will mass adjust all FQHC claims with dates of service on or after January 1, 2017, through December 31, 2017, for carrier locality 0118272 within 90 days of the implementation of CR10334.
Here is the link to the MLN MattersŪ article MM10334 external pdf file.
Source: MM10334
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