Updates from your ACE team
Expand your practice to achieve financial independence
There are only 34 days left in 2019, and it's a great time to finalize planning for next year. In our last issue we focused on some building blocks that will help you finish this year strong and boost the next one. In particular, we talked about seeking retroactive reimbursement for self-pay balances (this can offer a quick return), accurate credentialing (it's one of the top denial reasons we see each day), and how integrated behavioral health can provide significant expansion opportunity, and additional care options for your patients.

This month, we look at partnering for expansion and what's happening in the industry as we head toward the end of the year. There's been a lot of focus on health centers - November 12 th was Unity for Community Health Day, a day organized by NACHC to promote advocacy for community health centers. November 21 st was National Rural Health Day, and there are a number of webinars and activities happening during the week. There is still uncertainty around long-term funding for the Community Health Center Fund (CHCF), although it has been extended again through December 20 th.

Use of technology definitely looks like it will become even more prevalent next year, with CMS releasing 2020 Physician Fee Schedule rules covering remote monitoring, care coordination and value-based care, and telehealth services. This is exciting as it will provide additional service options for patients, and reduce some of the administrative burden for providers. CMS is also focusing on the long-term sustainability of Medicaid, so we take a look at how that may impact FQHCs.

Keep reading for more details.
Happy Thanksgiving from ACE!
It's the season of giving thanks, and we're grateful for everything you do! We feel so privileged to be a part of this community.

On behalf of our ACE family, we wish you and yours a very Happy Thanksgiving!

In observance of the holiday, our office will be closed on Thursday, November 28 th and Friday, November 29 th .
Practice expansion through partnership
Do you have partnerships in place with like-minded facilities and providers in your area? This is one of the best ways to expand your practice, generating new revenue streams and benefiting patients through additional services - and we've had great success for our clients. Want to know more? We're happy to provide references!!

Interestingly, Foley & Lardner are currently running a series covering topics of interest for FQHCs, and recently published this article discussing the benefits of FQHC contracting relationships from the provider perspective. Well worth a read!
Medicaid and FQHCs
There's been a lot of focus on Medicaid lately. NACHC recently published an article titled "Health Centers Serving More Medicaid Patients Than Ever", with analysis showing that community health centers served 1 in 5 Medicaid beneficiaries in 2018 (up from 1 in 6 the previous year). This growth is significant because health centers generate cost-savings for the public insurance program, as patients have access to the services they need under one roof. Also because funding and payment models for the Medicaid program are currently under review, which may negatively impact health centers and their patients. See the article for details on a recent study published by the George Washington University.

In a speech to the National Association of Medicaid Directors last week, CMS Administrator Seema Verma discussed the importance of protecting the nation's vulnerable, and ensuring the long-term sustainability of Medicaid and other support programs. To achieve this, Ms. Verma announced that CMS will be making changes to grant and payment models designed to drive value-based care. It is also driving accountability for results through initiatives such as the Medicaid and CHIP Scorecard (which was recently updated to include new data available to the public).

What does this mean for FQHCs? At this stage the direct impact is unclear; we'll monitor any changes and keep you informed as they roll out. In the meantime, we recommend that you continuously check self-pay balances for any claimable retroactive Medicaid payments (see our handy fact sheet), and also make sure that you're receiving the maximum reimbursements allowable.
Media watch and other useful info
CMS: using technology to support patients

CMS has released the 2020 final rule which includes changes relating to telehealth and other technologies, effective from January 1, 2020. Not all of the changes apply to RHCs or FQHCs, with reasons explained below, however we bring them to your attention since they reflect future trends.

Consent for Communication Technology-Based Services (CTBS)
As part of their Patients Over Paperwork initiative, CMS is committed to reducing administrative burden, and will now allow providers to obtain a single consent (at least once per year) from a patient covering multiple CTBS services or interprofessional consultation services. The previous requirement was once per service.

New virtual care codes
Titled "Communication Technology-based Services", CMS has introduced three new HCPCS G codes for bundled service treatments for opioid use disorders (OUD). The codes cover office-based treatments that are commonly provided remotely using technology.

** NOTE: For RHCs or FQHCs, CMS has not created a new G code for these services, stating " RHCs and FQHCs that provide OUD services to their patients can bill for individual psychotherapy services using a range of CPT codes that are billable visits under the RHC all-inclusive rate (AIR) and FQHC Prospective Payment System (PPS) when furnished by an RHC or FQHC practitioner. These codes can be billed on the same day as a qualified primary care visit, and RHCs and FQHCs can also bill for care management services and receive a payment in addition to their AIR or PPS payment."

Remote patient monitoring (RPM)
Of ficially titled "Chronic Care Remote Physiologic Monitoring", CMS finalized two changes:
  1. RPM can be furnished “incident to” under general supervision; and 
  2. CPT Code 99458 is a new add-on code for patients who receive an additional 20 minutes of RPM services in a given month (i.e. 40 minutes of RPM services). 

** NOTE: the rule does not apply for RHCs or FQHCs. " Services such as RPM are not separately billable because they are already included in the RHC AIR or FQHC PPS payment.  

NNOHA: Resource for dental providers
Increasing access to  oral healthcare  for underserved populations is a high priority for HRSA, and they recently awarded over $85 million dollars to health centers for that purpose. The  National Network for Oral Health Access (NNOHA) provides a wide range of resources to help safety net oral health programs and providers.

Their promising practices in Dental Program Management,Clinical Excellence and Access to Care describe models and strategies related to Mobile Dentistry, Staffing, Workforce Recruitment, HIV Testing in the Dental Chair, Tele-dentistry, Process Redesign, and more. Their  webinar recordings and slides  are a great resource for health center staff, as well as their Operations Manual  addressing Workforce, Financials, Risk Management and other important aspects of running a successful safety net dental program. One of the best resources they offer is their Oral Health Infrastructure (OHI) Toolkits, with options for both new and existing programs. Find these resources and more on the NNOHA website

Unity for Community Health Day
On November 12 th NACHC conducted the first Unity for Community Health Day, where they asked everyone to advocate for health centers by meeting with congressional members or calling in to their members’ offices. The day was a huge success, and NACHC would love to hear from you if you participated.

2020 Emerging Leader Awards
Do you have a young staff member who you think deserves national recognition?

 Nominate them for the 2020 Emerging Leader Awards , presented by the Geiger Gibson Program in Community Health Policy! Nominations close January 6, 2020.

Stay up to date with HRSA's latest news.