Federally Qualified Health Centers and what do they do?
A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities. FQHC is a non-profitable, consumer-directed healthcare organization. FQHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. FQHCs were originally meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency rooms.
These include community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “look-alikes.” They also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization. CHCs/FQHCs are paid based on the FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner.
Their mission has changed since their founding. Their mission now is to enhance primary care services in underserved urban and rural communities
Virtual communication services in FQHCs
With effect from January 1, 2019, CMS has released a new reimbursement plan for FQHCs. It says,
“FQHCs can now receive payment for virtual communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an FQHC practitioner to a patient”
The patient must have had an FQHC billable visit within the previous year, and both of the following requirements are met:
- The medical discussion or remote evaluation is for a condition not related to an FQHC service provided within the previous 7 days
- The medical discussion or remote evaluation does not lead to an FQHC visit within the next 24 hours or at the soonest available appointment
How can FQHCs receive payment for virtual communication services?
To receive payment for Virtual Communication services, FQHCs must submit an FQHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services. Payment for G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services) and HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes.
What is the payment rate for G0071 and G2012?
HCPCS code G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services). HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes. For 2019, the payment amount for code G0071 will be $13.69 (average of HCPCS codes G2012 and G2010).
What types of practitioners in FQHCs can furnish virtual communication services?
Technology-based communication and remote evaluation services are billable by FQHCs, only when the discussion requires the skill level of an FQHC practitioner. FQHC practitioners are physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists, and clinical social workers. If the discussion could be conducted by a nurse, health educator, or other clinical personnel, it would not be billable as a virtual communication service.
What types of communication technology can be used?
Virtual communication services should be initiated by the patient contacting the FQHC by
- Telephone call
- Integrated audio/video system or
- Store-and-forward method
Store and forward method include sending a picture or video to the FQHC practitioner for evaluation and follow up within 24 hours. The FQHC practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal.
How can HealthViewX help FQHCs in giving virtual communication services to their patients?
HealthViewX has the following features that will enable FQHCs in giving communication services to their patients,
- Inbuilt audio and video calling apps – HealthViewX supports audio and video calling options that help practitioners in contacting their patients easily.
- Secure messaging – HealthViewX has an asynchronous messaging option that enables providers to chat with patients and discuss their health plan.
- HIPAA compliant data security – The solution is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
With HealthViewX Patient Referral Management solution in hand FQHCs can stay in touch with their patients easily. A 30-minute demo with our team will help you know how effectively our solution can give virtual communication services to your patients. To know more schedule a demo with us.