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FQHCs: 2019 New Medicare Services and G Code Payment Updates

AAFCPAs would like to make Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) clients aware that the Centers for Medicare & Medicaid Services (CMS) has issued important reimbursement updates related to virtual communication services, and Medicare G Code rates for 2019.

Virtual Communication Services

Effective January 1, 2019, RHCs and FQHCs may now receive payment for virtual communication services when at least 5 minutes of communication technology-based or remote evaluation services are performed to a patient that has had a billable visit within the previous year and has met the following requirements:

  • The medical discussion or remote evaluation is for a condition not related to an RHC or FQHC service provided within the previous 7 days, and
  • The medical discussion or remote evaluation does not lead to an RHC or FQHC visit within the next 24 hours or at the soonest available appointment.

The new Medicare G code to receive payment for virtual communication services is G0071.  This code can be submitted alone or with other payable services.  The rate for G0071 is set at $13.69 for 2019.

Please reference the Centers for Medicare and Medicaid Services’ (CMS) Virtual Communication Services Frequently Asked Questions for additional information: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/VCS-FAQs.pdf 

Medicare G Code Rates for New and Established Patient Visits

For 2019, Medicare has increased the FQHC and RHC allowables for new and established medical and mental health patient visits.  The new base allowable for codes G0466 through G0470 is $169.77.  Medicare has also updated the Geographic Adjustment Factors (GAF) for 2019.  The new GAFs for the New England area are as follows:

  • Metro Massachusetts 1.101
  • Rest of Massachusetts 1.042
  • Rhode Island 1.038
  • New Hampshire 1.021
  • Southern Maine 1.003
  • Rest of Maine 0.963
  • Vermont 1.007
  • Connecticut 1.064

The total Medicare allowable will be the base rate times your specific GAF and applicable payment adjustments for new patient visits.  The total allowable for the G codes could range from $178 to $250.

What do we advise?

AAFCPAs advises clients to perform routine maintenance of the Charge Description Master (CDM) at least annually, and ideally quarterly. Additionally, the CDM should be examined outside of routine maintenance at the time of payer contract changes such as these, or with the addition of new services or other internal corporate changes.

AAFCPAs reminds healthcare clients of the critical impact an accurate and up-to-date CDM can have on the organization’s revenue cycle success. Please reference our blog on Best Practices for Maintaining Your Charge Description Master to Maximize Revenue. The CDM is the central mechanism of the revenue cycle, and the accuracy of the data elements serves as a link between service delivery, billing, and optimal reimbursement. Missing charges, over charges, and coding errors can adversely impact your revenue and create significant compliance issues, including penalties for charge overages. Keeping an accurate CDM will help maximize revenue and avoid payer denials.

AAFCPAs’ Healthcare Advisors may help facilitate these changes by:

  • Providing 2018 revenue estimates
  • Assisting with enterprise performance management (EPM) and electronic health records (HER) system changes/updates
  • Assisting with reporting of coding and denials
  • Assisting with staff training
  • Providing a complete billing analysis, including but not limited to:
    • CDM examination
    • Financial/data reporting
    • Contract examination
    • Process improvements
    • Technology implementations
    • Denial trend analysis
    • Financial/cost analysis

If you have questions please contact Matt Hutt, CPA, CGMA, at 774.512.4043, mhutt@nullaafcpa.com; or your AAFCPAs Partner.

About the Author

Matthew Hutt CPA
Matt leads AAFCPAs’ Healthcare Division, providing assurance, tax and advisory solutions for Federally Qualified Health Centers (FQHCs), behavioral health providers, home care agencies and hospices, nursing homes, and senior care living centers. Matt advises healthcare providers on consolidation and coordination of care, including the integration of behavioral health into the primary care delivery system. He also provides consulting solutions for providers transitioning to new value-based reimbursement models, and data driven patient care, including: developing business process and controls for collecting and advantaging data to provide analysis on: provider activity, delivery of care, and analysis of efficiency & cost effectiveness. Matt is also highly-sought after for his knowledge on issues related to affordable housing developers with requirements related to the US Department of Housing and Urban Development, MassHousing, Low Income Housing Tax Credits, Historical Tax Credits and New Markets Tax Credits.