New Medicare Changes Simplify RPM and CCM for RHCs and FQHCs delivering Rural Health

July 9

New Medicare Changes Simplify Remote Patient Monitoring and
 Chronic Care Management for RHCs and FQHCs

Great news for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)! The Centers for Medicare & Medicaid Services (CMS) has announced significant changes to the Medicare Physician Fee Schedule for the calendar year 2024. These updates bring some exciting opportunities, particularly in the areas of Remote Patient Monitoring (RPM) and Chronic Care Management (CCM).


Summary of the Details

The Centers for Medicare & Medicaid Services (CMS) have finalized regulatory changes aligning with Sections 4113 and 4121 of the Consolidated Appropriations Act (CAA), 2023. These changes extend payment for telehealth services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) through December 31, 2024. This extension introduces Medicare coverage and payment for Intensive Outpatient Program (IOP) services by RHCs and FQHCs, as detailed in the CY 2024 Outpatient Prospective Payment System rule. The definition of direct supervision has been broadened to include virtual presence through December 31, 2024. Behavioral health services "incident to" a physician or NPP’s services now require general, rather than direct, supervision.

HCPCS code G0511 has been updated to incorporate Remote Physiologic Monitoring and Remote Therapeutic Monitoring and includes Community Health Integration (CHI) and Principal Illness Navigation (PIN) services. From January 1, 2024, RHCs and FQHCs can bill these services alone or with other payable services using HCPCS code G0511. The payment rate for G0511 will now reflect the utilization frequency of these services. Finally, while beneficiary consent for chronic care management and virtual communications services remains mandatory, the mode of obtaining consent can vary, and direct supervision is not necessary.

A change is also being finalized in the methodology for calculating the payment rate for the general care management HCPCS code G0511, which will take into account how frequently the various services are utilized. 

Finally, a clarification has been made regarding obtaining beneficiary consent for chronic care management and virtual communications services. Although it is required, the mode of obtaining consent can vary, and direct supervision is not needed.   

Why This Matters

Remote Patient Monitoring and Chronic Care Management are crucial for managing long-term health conditions, especially in rural and hard-to-reach areas. With the updated billing code G0511, RHCs and FQHCs can deliver these essential services more seamlessly.

Benefits for Providers

  • Efficiency: Streamlined billing processes save time and effort, allowing providers to focus more on patient care.
  • Financial Incentives: With easier billing procedures, clinics can better manage their finances and potentially increase revenue through expanded service offerings.

Benefits for Patients

  • Better Access: Patients in rural and underserved areas can now access high-quality remote care services without the need for frequent in-person visits.
  • Enhanced Care: RPM and CCM services allow for continuous monitoring and management of chronic conditions, improving overall health outcomes.
  • Convenience: Remote care reduces the need for travel and minimizes disruptions to patients' daily lives.

Next Steps for RHCs and FQHCs

If you're an RHC or FQHC provider or billing specialist, here are some steps to take advantage of these changes:

  1. Review the CMS Guidelines: Familiarize yourself with the updated Medicare Physician Fee Schedule and the details of billing code G0511.
  2. Train Your Team: Ensure your Nurse Practitioners and billing specialists are aware of the changes and understand how to implement them.
  3. Update Your Systems: Make any necessary adjustments to your billing systems to accommodate the new code and streamline your processes.
  4. Communicate with Patients: Inform your patients about the expanded services and how they can benefit from RPM and CCM under the new guidelines.

Conclusion

The CMS updates to the Medicare Physician Fee Schedule for 2024 bring exciting opportunities for RHCs and FQHCs. By simplifying the supervision requirements for billing code G0511, CMS is making it easier for clinics to offer essential RPM and CCM services. These changes not only benefit providers by streamlining processes and increasing flexibility but also enhance patient care and accessibility.

Stay informed and make the most of these new opportunities to improve care delivery and patient outcomes in your community.

For more detailed information, visit the CMS Fact Sheet.

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This blog post has aimed to translate complex regulatory changes into actionable insights for RHC and FQHC providers and billing specialists. We hope this information helps you adapt to the new guidelines and continue offering top-notch care to your patients.

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Tags

G0511, Rural Health


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