Updates from your ACE team
We're all in this together.

As we continue toward the peak of the coronavirus (COVID-19) and the disease continues to spread, it's important to remain calm, keep the positivity alive and start implementing solutions that will increase your FQHC's revenue.

This newsletter, we discuss the issues private primary care providers and rural hospitals are facing because of COVID-19, why the virus is causing them to close their doors and what opportunity and benefit this presents those primary care providers and your providers, patients and facility. This newsletter also addresses the 2020 NACHC stats, but more importantly the patients with underlying health conditions, or chronic diseases the stats highlight... and how to transition from in-person visits to telehealth and by implementing a home health delivery program, you can help them stay home, stay healthy and away from possible COVID-19 cases.
Does your patient base require contracts with an additional hospital or a primary care provider... or three?
When we talk about the front lines of health care, we often think of nurses and doctors that are treating patients in the hospital. They are on the front lines, but only for that facility and patient.

When we talk about an epidemic or a pandemic, the front lines are community health centers and primary care practices that may be a part of a group or a practice or alone as a small business. Primary care practices and small business across America are, if they haven't already, going to face a strain. According to a Modern Healthcare article, COVID-19 pushing primary care to brink of collapse , the recommended telehealth visits that work to prevent sick patients from spreading the infection provide 30 percent less revenue than face-to-face visits.

What's more, according to HealthLeaders' article from April 8, A Quarter of Rural Hospitals at 'High Risk' of Closure, COVID-19 likely to make it worse , shares "one quarter of rural hospitals (more than 350 rural hospitals) are at risk of closing due to financial challenges." One of the largest causes of this is that more than 75 percent of patients are going to receive care out of their area. How much money does this translate to? $8.3 billion in total patient revenue. The top five states most likely to experience this are Tennessee, Oklahoma, Mississippi, Alabama and Kansas.

If these practices and hospitals close, it will hurt the front line's defense against COVID-19, something none of us can afford. Are you ready to expand your provider base through contracts?
Community health centers are important!
Last month we touched on the National Association of Community Health Centers' (NACHC) 2020 chartbook , Community Health Center Chartbook, which details the overall importance of community health centers and the impact they have on the communities they serve.

As COVID-19 continues to spread across the nation, it's important to review the patient database that utilizes a community health center and as the funding date continues to creep closer, it's crucial to start looking at how community health centers can leverage services to become financially independent.
COVID-19 is especially threatening to those that have underlying health conditions, or chronic diseases. How are you treating these patients and where are they getting their prescriptions filled? These are the patients that can help transform a facility to be financially independent. Is your 340B pharmacy ready to deliver medication to these patients through a home delivery program? Keep your patients, staff and providers safe and healthy through a home delivery program and telehealth.
Have you closed your encounters?
A billing issue we're seeing a bit of is open encounters or charts. Open charts/encounters are a billing issue because they don't get paid. When is the last time you checked in on the number of charts/encounters still open from last year, the beginning of this year or the beginning of the month? It's important to close the charts and encounters in order to be properly compensated, especially now.
Implementing value-based care and quality measures
This is an interesting time to be in healthcare. COVID-19 is changing the way providers are treating patients. Some hospitals have leveraged tele-monitoring to combat the personal protective equipment (PPE) shortage, to keep patients isolated at home while still providing care and keeping hospital beds open for those that really need them. Large companies like GM , Nike and Fanatics have started making health care equipment, from ventilators to PPE, to combat the shortage.
Quality measures and quality health care still matter and are at the forefront of patient care. Quality measures work to optimize health outcomes by improving quality and transforming the health care system . They are able to work toward transforming health care because providers and their organization are monetarily credited for the ability to reduce the amount and probability for return visits. This is measured through "evidence-based and practice-specific data in the categories of quality, improvement activities [that advance] care information and cost." Centers for Medicare and Medicaid (CMS) updated the quality measures as of January 29, 2020, click here for more information.

Are you utilizing quality measures to increase your reimbursement from payers? Failure to implement quality measures may result in reduced payments, lowering star ratings, removing insurer-allocated patients or canceling contracts.
How to receive commonly missed revenue from past patients
We featured the passive income of medical billing and why it's important in the January newsletter . If you aren't tracking the patients that visit and then - days, weeks, months - later become eligible for Medicaid, you are leaving money on the table. There is no time like the present to start tracking those patients, especially when there are conversations about uncertain funding and the pressure COVID-19 is putting on community health centers.

We understand that it may currently be challenging to monitor this payment process between trying to figure out the new telehealth codes that are changing daily and billing processes, but we're here to help! We have a dedicated team that will track and collect on your newly Medicaid enrolled patients. Sound too easy? Check out our flyer for more information!
Here's everything we know about telehealth and COVID-19
Emergency healthcare policies and funding are being created and implemented as we move through this pandemic. Telehealth is included in the new developments. While telehealth billing for the pandemic isn't completely solidified and the payers aren't ready to start receiving the claims yet, CMS has been lobbying for providers to receive the same amount from payers as an in-person visit . Here's everything we know from Center for Connected Health Policy that qualifies for a telehealth visit:
  • Location of the patient: rural and site limitations have been removed. Telehealth services may be provided regardless of where the patient is located geographically and the type of site, allowing the home to be an eligible originating site.
  • Eligible services: Medicare expanded the list of eligible services provided via telehealth. Click here for the list of codes.
  • Modality: CMS clarified in its Final Interim Rule that for telehealth, services a "telecommunications system" means "multimedia communications equipment that includes audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.
  • Out-of pocket costs/co-pays: still applies; OIG is providing providers flexibility to reduce or waive fees.
  • Prior existing relationship to provide care via telehealth: services via telehealth and remote patient monitoring and virtual check-in can be provided to new and established patients.
  • Supervision: physician supervision may be provided using live video. For other supervision changes," click here for the CMS Provider and Practitioner Guidance.
  • Virtual check-ins: A brief (5-10 minutes) check in between a practitioner and patient via a telecommunications device (such as a phone) to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.
  • Telehealth visits: a visit with a provider that uses telecommunication systems between a provider and a patient.
  • E-visits: a communication between a patient and their provider through an online patient portal.
In efforts to fund telehealth services and devices for medical providers, the Federal Communications Commission (FCC) developed and approved a $200 million program. Medical schools and teaching hospitals, community health and mental and migrant care centers, local health agencies and departments, not-for-profit hospitals, rural health clinics and skilled nursing facilities are eligible for this funding and may apply for up to $1 million to cover the cost of new devices, services and personnel.

For more guidance on telehealth, click here. We'll continue to keep you updated as this develops and is updated.
Media watch and other useful info
According to a NACHC newsletter, Congresses' leaders are identifying priorities for future packages. During a press call on April 1, "Speaker Pelosi mentioned plans to set aside $10 billion for community health center funding in the fourth major COVID-19 package , expected to be passed when Congress returns from recess later this month." On April 8, 2020 , "the Department of Health and Human Services (HHS) awarded [over] $1.3 billion to 1,387 health centers through Health Resources and Services Administration (HRSA) [for the COVID-19 pandemic." Health centers that are funded by HRSA are able to use the funds to assist "communities detect COVID-19, prevent diagnose, treat the disease and maintain or increase health capacity and staffing levels to address" COVID-19.

As COVID-19 continues to spread across the nation, the United States' medical community is responding by canceling, postponing and updating some of its events to be virtual. Click HERE to check the status of your event.

As this pandemic continues around the world, Modern Healthcare has put together a tracker list that is regularly updated with the regulatory status of tests in the US, European and Asian markets.

Xtelligent Healthcare Media editors put together a podcast for the "healthcare professionals [that are] seeking solutions to today's and tomorrow's top challenges. [The podcast] focuses on real cases that are leading to tangible improvements in care quality, outcomes and cost. [Special] guests include leading [providers, payers, the] government and other organizations. [The special guests take the time to] share their approaches to transforming healthcare in a meaningful and lasting way."

CMS' news alert from April 7, 2020 summarizes all of CMS' latest actions concerning COVID-19. CMS has and continues to offer immediate relief so states can care for the most vulnerable patient population(s).

On April 8, 2020, CMS released guidance concerning how to control the COVID-19 infection spread. The guidance is to grant "local hospitals and healthcare systems," the ability to "rapidly expand their capacity to isolate and treat the patients infected with COVID-19."

Click HERE for CMS' latest guidance updates on infection control.

As community health centers across the country continue to be the front lines for treating COVID-19, NACHC is seeking your stories to strengthen its efforts to extend the funding past May 22, 2020. Call 301-347-1550 and follow the prompts to share your experiences.

NACHC is following COVID-19. Stay updated with their COVID-19 information for community health centers here .

Stay updated with HRSA's latest information about COVID-19 here .