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New Reimbursement for Community Health Centers Using Technology

Providers working in rural and underserved communities can now bill Medicare for virtual check-ins with patients

Provider reviews patient recorded videos on a computer
A new Medicare billing code reimburses Federally Qualified Health Centers and Rural Health Clinics for reviewing recorded patient videos.

New Medicare payment policies are now in effect, meaning providers are able use several new reimbursement codes to support patients through treatment using technology. This year’s Medicare policies include several updates to encourage efficient, effective, and patient-centric communication tools.

One important new code is G0071, which reimburses Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for virtual communication with patients. Providers at these facilities are able to use this new code starting January 1, 2019.

Medicare reimbursement for FQHCs and RHCs supporting patients through technology

The new code can be used to reimburse providers at FQHCs and RHCs for using technology in two ways:

  1. Reviewing a recorded video or photo sent by their patients and following up within 24 hours.
  2. Having a brief, real-time discussion with the patient, such as over the phone or a livestream video chat, to determine if he or she needs an in-person appointment.

Medicare clarified that if the requirements for the code are met, these virtual check-ins are considered separately billable when not part of another service provided by the FQHC or RHC.

There are a few other requirements that providers must meet in order to receive reimbursement through G0071:

  • The communication cannot be related to a service provided within the previous 7 days or within the next 24 hours.
  • The practitioner must provide at least 5 minutes of communication technology-based or remote evaluation services.
  • Patients must consent before the interaction takes place.
  • It must be for an established patient seen within the past year.

Improving medication adherence with mhealth technology

The new Medicare code offers a more convenient way to support patients and stay connected to them throughout care, potentially lowering healthcare costs if used to improve medication adherence.

Each year, medication nonadherence results in approximately $300 billion in spending due to worsening health conditions that require costly care. One of the most effective ways to improve medication adherence is through Directly Observed Therapy, a public health practice where a healthcare worker observes a patient take every dose of medication and provides support throughout treatment. Mobile technology makes it possible to offer this service to more patients, which could result in savings across the health system.

Using emocha’s mobile app, patients video record themselves taking their medication and report any symptoms or side effects they are experiencing. Providers use a web platform to review those videos and engage with patients. Under the new Medicare payment policies, providers at FQHCs and RHCs will be able to bill G0071 for reviewing videos sent by their patients with emocha. CMS specifically highlighted that G0071 is to be billed independently of the all-inclusive rate for visits, opening up a new channel for patient engagement.

Research shows that emocha helps patients take 94 percent of their medications as prescribed. Contact us to learn more about how FQHCs and RHCs can use emocha to help patients take their medications and avoid the serious and costly consequences of nonadherence.