PC Pricer: FQHC PPS Pricer Code
Guidance for the logic used by the FQHC PRICER program to calculate the PPS rate.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 11, 2020
The Affordable Care Act mandated the development of a prospective payment system (PPS) for Medicare payments to FQHCs beginning on October 1, 2014, and requires that Medicare payment under the FQHC PPS shall be 80 percent of the lesser of the actual charge or the PPS rate.
There is no PC Pricer application for the FQHC PPS at this time. The files contain the logic used by the FQHC PRICER program to calculate the PPS rate.
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