PPS isn't standard billing. Your RCM partner should already know that.

Federally Qualified Health Centers get reimbursed through a bundled, per-visit Prospective Payment System — not line-item fee-for-service. Miss a qualifying-encounter detail, and you don’t lose one code. You lose the whole visit payment.

>96%

First-pass rate

<60

Avg. AR days

40%+

Denial rate reduction

29K+

Denials resolved / month

270+

RCM experience

The FQHC Reimbursement Reality

PPS changes what actually matters in billing — and most RCM vendors are built around fee-for-service instead:

PPS pays one bundled rate per qualifying visit — in 2026, the national Medicare base rate is $207.72, adjusted by your center’s Geographic Adjustment Factor. Miss the qualifying-encounter documentation, and the whole visit payment is at risk, not just a line item.

New-patient encounters and Initial Preventive Physical Exams or Annual Wellness Visits carry a 34.16% payment increase — billed incorrectly, that’s real revenue left on the table on every eligible visit

Medicaid often reimburses through its own state-specific PPS or alternative payment methodology, plus wraparound payments to true up managed-care encounters to the PPS rate — a reconciliation most general RCM vendors have never actually run.

UDS reporting to HRSA and sliding-fee-scale documentation sit on top of billing as compliance requirements — miss them, and it’s not just a denial, it’s a federal compliance finding.

None of this is what a general fee-for-service RCM vendor is built to run.

Sound familiar? You’re not fully confident every eligible new-patient encounter is capturing its full payment adjustment. Your Medicaid MCO wraparound reconciliation hasn’t been checked against your actual PPS rate in longer than you’d like to admit. Or UDS reporting season is the most stressful few weeks of your year. Any one of these is the moment to have this conversation.

The Neolytix Answer

Revenue cycle operations built around PPS mechanics — not adapted from fee-for-service billing.

Services for FQHCs & Community Health Centers

One managed team, every service your center actually needs.

Your revenue runs on two tracks — providers becoming billable, and patients moving from intake to a paid encounter. Under PPS, both tracks turn on documentation rather than line items.

Tap a stage to open its details

Why Not Just Buy Software, or Go Offshore?

"Here's a platform — you run it."

Practice-management software vendors will sell your platform a centralized system, but your ops team still configures it, trains every acquired site’s staff on it, and owns the transition timeline alone — headcount and time most post-close integration plans don’t have.

"Send us your claims — we'll handle it."

Generic offshore billing shops can absorb volume, but they don’t understand deal timelines, tax-ID structures, or what a PE-backed CFO actually needs to report upward — you end up managing the vendor as closely as you’d manage doing it in-house.

Neolytix runs revenue cycle operations built around PPS mechanics specifically, not general medical billing with an FQHC label attached.

	Fully Outsourced	Neolytix managed operation + platform intelligence	Fully Software-Based
Work leaves your team's plate — Billing, follow-up, and enrollment handled for you, not by you.
Real-time dashboards & automation — Live visibility and intelligent workflows, not month-end summaries.
Expert judgment on complex claims — Specialty-trained people decide the edge cases automation can't.
No migration or adoption burden — Runs inside your existing EHR/PM; nothing for your staff to learn or abandon.
AI + human expert intelligence — AI prepares the work at machine speed; accountable experts approve the judgment calls.

For Your Billing Team, Not Around Them

If you’re the person currently keeping FQHC billing, UDS reporting, and wraparound reconciliation together — this isn’t a pitch to replace you. It’s an offer to give you a standard built around PPS specifically, instead of one adapted from fee-for-service billing. Most teams we work with keep their billing staff in place, shifted toward higher-value work — compliance reporting, patient-facing follow-up, exception handling — instead of reconciling every managed-care encounter by hand.

Proof

Case Studies

PATIENT ACCESS · ENT & ALLERGY · 15 LOCATIONS, SOUTHERN CALIFORNIA

One patient access standard, held across 15 sites.

6.6x

team growth (5 → 33 specialists)

95%

call resolution, up from 86%

14% → 5%

unresolved calls

“When LACENTA’s network growth outpaced what conventional hiring could deliver, Neolytix took end-to-end ownership of patient access and ran it as one standard across all 15 locations — language-matched staffing in four languages, living SOPs, the same workflows at every site”

Recovering 20% Lost Revenue After a Practice Merger

Breaking the Revenue Cycle Bottleneck — Behavioral Health AR reduced from 14% to 3.5% | $16K+ Medicare revenue recovered

Security-First. At Every Step.

Built for Compliance. Designed for Confidence.

Every service we deliver is built on a foundation of strict data governance and regulatory compliance. HIPAA safeguards and ISO 27001-certified security practices are embedded into how we work, not added after the fact.

Get in Touch With Us

FAQs

Frequently Asked Questions

How is PPS billing different from what our current biller does?

PPS pays one bundled rate per qualifying visit rather than paying line by line — so the documentation that makes a visit “qualifying,” and adjustments like the new-patient or IPPE/AWV increase, matter more than they would under standard fee-for-service. We build billing around capturing those correctly, not around processing individual codes.

Do you handle Medicaid wraparound reconciliation?

Yes — reconciling managed-care encounter payments against your actual PPS rate is part of how we support FQHC billing, not a separate add-on.

Can you help with UDS reporting season?

We support the billing and encounter-data accuracy that UDS reporting depends on; we’ll scope the exact level of reporting support on a call based on your center’s current process.

What does the commercial model look like?

Percentage of collections plus gain-share — we’ll walk through the exact structure on a call once we understand your payer mix and PPS rate.

How do you handle security and compliance?

Neolytix is ISO 27001 certified and HIPAA-compliant, with the same security standard applied across every center we support.

How Neolytix Protected $15K+ from a Payer Denial Pattern for a Multi-State Behavioral Health Practice

From Reactive Denials to Preventive Accuracy: How Saint Michael’s Medical Center Cut Inpatient Billing Errors by 67% with Neolytix

From Denials to Predictive Control: How Prime Healthcare Achieved 98.5% First-Pass Enrollment Success

40% Aging AR Cut to 15-Day Claims: How Neolytix Transformed a Behavioral Health RCM

If you’re managing more than one location and you’re not sure your billing operation would tell you the truth about which site is actually underperforming and why — that’s the conversation worth having. Not a demo, not a sales script — a conversation about how your revenue cycle actually runs today, site by site, with someone who can tell you within the first call whether this is a fit.