BCA’s Favorite Resources 

Discover some of our most used resources for invaluable insight on FQHC/RHC management, quality improvement, and compliance. 

Coding, Billing, and Documentation 

American Medical Association (AMA), responsible for maintaining, revising and updating the CPT code set, https://www.ama-assn.org/practice-management/cpt/need-coding-resources 

Centers for Disease Control (CDC), houses online, accessible ICD-10-CM Official Guidelines https://stacks.cdc.gov/view/cdc/133289 

American Hospital Association (AHA) Coding Clinic, provides further clarification regarding official interpretation of ICD-10-CM Guidelines and Conventions. https://www.codingclinicadvisor.com/  

CMS HCPCS Resource page, shares helpful information regarding the application, maintenance, and revision process for HCPCS, include CPT and HCPCS Level II https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system 

Medicare’s NCCI Edits and Policy Manual, provides edits to ensure CPT codes are not unbundled inappropriately, as well as a policy for appropriate application per CMS’ standards, https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits 

Medicare Claims Processing Manual, outlines specific information for RHCs and FQHCs to process Medicare claims, https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c09.pdf 

Medicare Benefit Policy Manual, provides comprehensive guidelines and regulations governing the coverage and reimbursement of services provided under Medicare in the RHC and FQHC settings, https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c13.pdf 

Medicare’s Physician Fee Schedule Relative Value Files, assigns work, malpractice, and total RVUs to all CPT codes, assisting with sequencing and valuation of service codes, https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files 

Value-Based Care, Quality Improvement 

eCQI Resource Center, standard measures used to report quality of patient care, https://ecqi.healthit.gov/ecqms  

Value Set Authority Center, for true quality data nerds, this provides a deep dive into what makes up eCQM quality measures (free registration is required), https://vsac.nlm.nih.gov/ 

HCPLAN, guidances on the APM (alternative payment model) framework and how to set value-based payment goals, https://hcp-lan.org/apm-framework/#1466616061212-90aa276e-30af 

National Committee for Quality Assurance (NCQA), resource for improving healthcare quality through value-based care, https://www.ncqa.org/ 

Agency for Healthcare Research and Quality (AHRQ), research and evidence-based resources to improve healthcare quality, https://www.ahrq.gov/ 

Healthy People 2030, provides data-driven objects to acheive national health and well-being goals, https://health.gov/healthypeople 

Institute for Healthcare Improvement (IHI), resource for quality improvement initiative advancement, innovative praciecs, and collaboration across healthcare settings,  https://www.ihi.org/ 

Healthcare Financial Management Association (HFMA), resources and education on value-based payment models, financial strategies, and operational best practices in healthcare, https://www.hfma.org/  

340B Program 

Office of Pharmacy Affairs (OPAIS), oversight of 340B Drug Pricing Program for purchase of medications at significantly reduced prices, https://340bopais.hrsa.gov/home 

340b University, education and resources to understand and implement the 340B Program, https://www.340bpvp.com/340b-university/online-learning 

FQHC-Specific Resources 

HRSA OSV Compliance Manual, outlines requirements for FQHCs to maintain compliance with grant requirements, https://bphc.hrsa.gov/compliance/compliance-manual 

HRSA Site Visit Protocol, outlines the procedures for operational site visits (OSVs) at health centers,  https://bphc.hrsa.gov/compliance/site-visits/site-visit-protocol 

HRSA Funding Opportunities, a great resource to search for available grants, https://www.hrsa.gov/grants/find-funding 

HRSA Federal Tort Claims Act Health Center Policy Manual https://bphc.hrsa.gov/sites/default/files/bphc/compliance/ftcahc-policy-manual.pdf 

FQHC Leadership Development and Coaching, https://www.jillsteeley.com/about

UDS Reporting and Results 

UDS Manual, guide for FQHC UDS reporting standards and requirements, https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2024-uds-manual.pdf 

UDS Data Overview, data source for all health centers UDS statistics, https://data.hrsa.gov/tools/data-reporting/program-data?type=AWARDEE 

HITEQ UDS Clinical Dashboards, a visual representation of clinical performance data for health centers for comparison of key clinical measures across the nation,  https://hiteqcenter.org/Services/UDS-Clinical-Dashboards/UDS-Clinical-Dashboard-National 

Compliance 

Health Care Compliance Association (HCCA), provides education, resources, and networking opportunities to healthcare compliance professionals to promote adherence to legal and ethical standards,  https://www.hcca-info.org/ 

Office of Inspector General (OIG), provides insight for upcoming audit and investigation regarding fraud, waste, and abuse,  https://oig.hhs.gov/ 

OIG Exclusions Database, online resource to search for individuals and entities excluded from participating in federally funded healthcare programs due to fraud, abuse, or other misconduct (it is incredibly important to make sure you have the right person by verifying middle initial and data of birth), https://exclusions.oig.hhs.gov/_gl=1*13a5r0c*_ga*NTEwNzc4NTIzLjE2OTc4MTY0NTI.*_ga_W5DCJS81Y5*MTcxOTYwMDI2OC4xLjEuMTcxOTYwMDUwOS4wLjAuMA.. 

Federal Poverty Guidelines 2024, provides ranges of poverty based on household income and family size, https://aspe.hhs.gov/sites/default/files/documents/7240229f28375f54435c5b83a3764cd1/detailed-guidelines-2024.pdf 

National and Regional Organizations 

National Association of Community Health Centers (NACHC), advocate for community health centers through the provision of training, leadership, and resources, https://www.nachc.org/ 

Northwest Regional Primary Care Association (NWRPCA), supports community and migrant health centers in Alaska, Idaho, Oregon, and Washington by offering training, advocacy, and resources, https://www.nwrpca.org/ 

Community Health Association of Mountain/Plains States (CHAMPS), provides advocacy, education, and support services to community and rural health clinics across Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming,  https://champsonline.org/ 

Additional Resources 

United States Census, for all kinds of demographic data, https://www.census.gov/ 

Health Affairs, peer-reviewed journal and leading resources for healthcare policy and research, https://www.healthaffairs.org/ 

Healthcare Information and Managment Systems Society, provides insight and education on healthcare IT, https://www.himss.org/