Medicare and Medicaid regulations can be complex and confusing. Rural health providers must often follow billing practices specific to their classification. Keeping current on codes, fee schedules and rules can be a challenge for even the savviest administrators and providers. At Aldrich, we understand the complexities of providing high quality care in rural locations and will work with you to provide clarity.
The Centers for Medicare & Medicaid Services (CMS) recently published the 2019 Medicare Physician Fee Schedule Final Rule, which includes a significant expansion of Medicare reimbursement for virtual communications furnished by Rural Health Clinics (RHCs).
Healthcare providers who serve remote rural areas often allow patients to call or email with a question or concern because it’s more convenient than having to make a long drive to the clinic. The challenge with this is the providers have traditionally not been reimbursed for their time and expertise.
Acknowledging that rural health clinics provide valuable care remotely, Medicare has approved a new billing code that reimburses these providers for brief advice, counsel, evaluations and consultations their staff provide through virtual communications services.
The Centers for Medicare and Medicaid Services expects the number of virtual check-ins for rural healthcare to eventually increase to more than 19 million, from fewer than 1 million in 2019.
The new billing code for the virtual communication services provided by RHCs is G0071. It took effect Jan. 1, 2019. The reimbursement rate is $13.69, including a patient copay of 20 percent, or $2.74.
The code applies only to contact initiated remotely—such as email, phone or patient portal—by RHC patients seen within the previous year. It also requires a doctor, nurse practitioner or other approved healthcare provider to spend at least five minutes responding to the patient’s questions or concerns.
This contact is not a substitute for a visit; rather, its purpose is to assess the patient’s concerns and determine whether a visit is needed. In order to be reimbursed under G0071, the virtual communications services provided by RHCs must meet several conditions:
The communication cannot be a follow-up about any service provided within the previous seven days.
The discussion or evaluation cannot result in an in-person visit within the next 24 hours or for the soonest available appointment.
The patient must communicate only with doctors, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists or clinical social workers.
The patient must initiate the remote contact. When the contact is made by the clinic, the reimbursement is included in the clinic’s all-inclusive rate (AIR) for payment from Medicare or Medicaid.
If, as a result of the virtual communication, the healthcare professional decides that a visit is warranted, the RHC should follow its usual billing practices for visits. The G0071 code can be submitted on the same claim as a billable visit—provided that visit has not occurred in the seven days prior to the communication or in the next 24 hours.
Note that there is no limit to how many times code G0071 can be billed per patient; however, excessive use is likely to trigger a review. Also, RHCs are not required to provide this type of remote service. Offering consults by phone, email, a secure patient portal or text remains optional for providers. Clinics that opt to offer this service need not register or seek any type of approval.
For help or support, feel free to contact the Aldrich Healthcare team with your questions.