Updates from your ACE team
Expand your practice to achieve financial independence
Let's make 2019 a year of expansion!

Last year, we focused on ways to improve and streamline core fundamentals like revenue cycle management and 340B pharmacy solutions, since these functions need to be operating efficiently to provide a solid foundation to build upon.

This year, our focus will be on growth. Over the coming months, we'll be closely following trends in areas such as behavioral health, quality measures, and chronic care management, and identifying initiatives that will increase your patient base, generate new revenue streams, and add value to your community.

And of course, we'll continue to provide handy tips and keep you informed of regulatory and industry changes. Don't forget you can always find key info in the resources section on our website.

In this issue, we'll touch again on retroactive Medicaid reimbursements since this provides ongoing revenue opportunity, and draw your attention to some very recent changes to Florida retroactive Medicaid eligibility rules. We'll highlight new CMS payment rules for 2019, share news from NACHC on proposed funding legislation for health centers, and provide a general reminder about 340B recertification.

We hope this information is useful, and we look forward to continuing to serve you and your community this year!
CMS CY 2019 Physician Fee Schedule Changes
From January 1, FQHCs can take advantage of changes to the 2019 Medicare Physician Fee Schedule that offer potential new reimbursement opportunities.
Virtual communication services
FQHCs can now receive payment for brief interactions between an FQHC practitioner and a patient using technology-based or remote evaluation services.

Key things to be aware of:
  • The new Medicare G code is G0071, with rate set at $13.69 for 2019
  • There must be at least 5 minutes of communication
  • Patient must have had a billable visit at the FQHC in the past year
  • Condition discussed cannot be related to an FQHC service provider within the past 7 days, and does not lead to a FQHC visit in the next 24 hours or soonest available appointment
  • The virtual service must be provided by a FQHC practitioner
  • Coinsurance applies to FQHC claims
  • Virtual communication services are not considered to be substitutions for an in-person visit, unlike telehealth services.
  • There is no limitation on the number of times this code can be billed for a single beneficiary

For more information, read the full rule and FAQs on the CMS website.
Chronic Care Management (CCM) services
In 2018, new G code G0511 was created with CPT codes 99490 and 99487, allowing FQHCs to differentiate claims for general vs. complex CCM services based on the time spent with the patient. These CPT codes can be used for CCM services provided by auxiliary personnel under general supervision of the FQHC practitioner.

In 2019, an additional CPT code 99491 has been added to the G0511 code bundle, increasing the general payment rate to $67.03. The 99491 code should be used when the FQHC practitioner spends >30 minutes directly providing CCM services to the patient.

For more information, read the full rule and FAQs on the CMS website.
Grab your unclaimed self-pay billing revenue!
At the end of last year, we encouraged you to review your self-pay and charity patients to determine whether any had become eligible for Medicaid at a later date. In many cases, Medicaid coverage can be applied retroactively, which provides an ongoing opportunity to recoup revenue that  would have otherwise been written off! 

Please note recent changes in Florida take effect from February 1, 2019 that eliminate the three-month Medicaid retroactive eligibility period for adults (except those who are pregnant) aged 21 years and older. In these cases, reimbursement will be available from the first day of the month when the patient becomes eligible for Medicaid.
Media watch and other useful info

NACHC has endorsed new bipartisan legislation introduced earlier earlier this month which would provide reliable and dependable funding for health centers through 2024.

A summary of the bill and link to the original press release is available on the NACHC website.
340B Recertification

Each year, 340B covered entities are required to recertify with the Office of Pharmacy Affairs (OPA) to continue participating in the 340B Drug Program.

The window for recertification is January 28 through February 25, 2019. For more information about the process, refer to the HRSA website.
Stay up to date with HRSA's latest news.