Increasing Success With CCM FQHC

Section 1: Introduction to FQHCs and RHCs

1.1 What is the Chronic Care Management Program?

2.1 How can Chronic Care Management help?

2.2 Who is eligible for the Chronic Care Management Program?

2.3 How is CCM reimbursed ?

2.4 What are chronic conditions?

Section 3: How Chronic Care Management helps FQHCs and RHCs.

3.1 Key reasons FQHCs and RHCs should offer virtual care:

3.2 Important consideration for FQHCs and RCHs while implementing the virtual care programs:

3.3 Reimbursement Codes for the CCM Program for FQHCs.

Section 4: EHI Program for FQHCs

4.1: Full-Service Solution

4.2 Software as a Service

Section 5: Why choose EHI for CCM services?

Section 6: What should FQHCs and RHCs look for while shortlisting the vendors?

Introduction to FQHCs and RHCs

What are FQHCs and RHCs?

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are government-funded programs that provide primary care and other services to underserved communities. While FQHCs can be located in both rural and urban areas, they must serve medically underserved populations. These centers are required to provide free or reduced-cost healthcare to low-income families and operate as non-profit or public entities. On the other hand, RHCs primarily serve rural areas where healthcare services are limited and are eligible for special reimbursements for Medicare and Medicaid patients.

Although both FQHCs and RHCs adhere to Medicare health and safety standards, they can also benefit from programs such as Chronic Care Management (CCM) to help identify gaps in care and enhance connections with their patient populations.

While offering primary care services, FQHCs and RHCs are often constrained by resources and budget limitations. Some facilities manage these programs in-house, while others collaborate with outsourcing partners to provide virtual care services. This is especially important for identifying care gaps, improving patient relationships, ensuring quality care, and reducing costs.

FQHCs and RHCs should prioritize virtual care services, especially as these programs can greatly expand healthcare access for underserved populations in rural areas. This approach removes geographical barriers, helps improve health outcomes, and can be a cost-effective solution for both patients and providers. Virtual care, such as simple check-in calls or preventive care, helps patients who face challenges like transportation issues or geographical distance from healthcare facilities.

2.0 What is the Chronic Care Management Program?

The Chronic Care Management (CCM) Program was created by the Centers for Medicare & Medicaid Services (CMS) to provide virtual care to Medicare patients who have two or more chronic conditions expected to last at least 12 months or until death.

For more information about chronic care management, visit the CMS - Chronic Care Management Factsheet.

2.1 How can Chronic Care Management help?

• Creates a personalized care plan that addresses health problems, goals, and medications.

• Assists in managing medications and their effects or side effects.

• Provides 24/7 access to healthcare professionals for urgent needs.

• Helps patients transition between healthcare settings.

• Coordinates care with pharmacies, specialists, and hospitals.

• Supports patients in setting and achieving health goals, fostering lifestyle changes, and monitoring progress.

2.2 Who is eligible for the Chronic Care Management Program?

Medicare or Medicaid beneficiaries with two or more chronic conditions are eligible. This includes patients at high risk for death, acute exacerbation, or functional decline.

2.3 How is CCM reimbursed?

Medicare Part B covers CCM, but patients are responsible for a 20% coinsurance payment. Healthcare professionals are reimbursed for the time and resources spent managing CCM patients.

2.4 What are chronic conditions?

Chronic conditions refer to long-term medical diseases or disorders that are not easily cured. Examples include arthritis, anxiety, cancer, depression, diabetes, obesity, and hypertension.

Section 3: How Chronic Care Management Helps FQHCs and RHCs

FQHCs and RHCs face continuous challenges in implementing preventative care programs such as Chronic Care Management and Remote Patient Monitoring, especially given labor and budget constraints.

FQHC and RHC patients particularly benefit from these services due to the prevalence of chronic illness and economic hardships in these areas. While RHC patients are in remote areas with limited access to healthcare, FQHC patients often face transportation difficulties in accessing healthcare services.

Implementing Chronic Care Management (CCM) allows these centers to generate additional revenue streams through grants and extend care outside of traditional office visits, helping providers stay connected with their chronically ill patient populations.

3.1 Key Reasons FQHCs and RHCs Should Offer Virtual Care

• Improved Patient Care: Virtual care eliminates the need for patients in remote areas to travel for healthcare, expanding access to care.

• Increased Patient Engagement: Programs like CCM and RPM enhance communication with patients, leading to better health outcomes by identifying potential issues early on.

• Cost-Effective Care: Virtual visits are less expensive for both patients and providers, which prevents chronic conditions from worsening due to delayed care.

• Improved Chronic Disease Management: Regular monitoring through virtual care helps manage conditions like hypertension, diabetes, and heart disease.

• Better Quality of Care: Virtual care facilitates enhanced coordination, which improves diagnosis and treatment plans.

Learn about best practices for family health care from the American Academy of Family Physicians.

3.2 Important Considerations for FQHCs and RHCs When Implementing Virtual Care Programs

• Technology Infrastructure: Reliable platforms and certified EMRs are essential for smooth patient experiences and data documentation.

• Clinical Staff and Resources: Effective outreach, engagement, and program operation require dedicated staff members.

• Patient Education: Ensuring that patients understand how to use virtual care platforms and programs is key to success.

• Privacy Compliance: Maintaining HIPAA compliance is essential when managing patient data.

• Reimbursement Policies: Understanding Medicare and Medicaid reimbursement policies ensures correct billing and compensation for virtual care services.

3.3 Reimbursement Codes for CCM Program for FQHCs

FQHC Providers use various CPT codes for reimbursement related to CCM services. These include:

• CPT 99490: First 20 minutes of non-complex CCM time spent by clinical staff.

• CPT 99439: Additional 20 minutes of non-complex CCM time.

• CPT 99491: Additional 30 minutes of time spent by a physician or qualified health professional.

• CPT 99437: Additional 30 minutes of time spent by a physician or qualified health professional.

Section 4.0 EHI Program for FQHCs

EHI assists FQHCs in improving health outcomes by offering a personalized Chronic Care Management (CCM) program that aligns with the practice's goals. Our team helps track critical health measures such as HbA1c, depression screening, and controlling high blood pressure.

4.1 Full-Service Solution

EHI provides a complete CCM solution, from patient enrollment and onboarding to monthly phone calls, charting, and providing superbills for billing.

4.2 Software as a Service

For clinics with in-house clinical staff, we offer a software-only solution to manage CCM processes, track time with patients, and create audit-proof documentation.

Section 5: Why Choose EHI for CCM Services?

EHI's CCM technology platform provides seamless access to patient health information, facilitating better care coordination and compliance monitoring. Our platform is designed to meet CMS documentation requirements and provides comprehensive care plans to support FQHCs in their virtual care efforts.

EHI’s CCM technology platform provides audit-proof documentation, comprehensive electronic care plans, and easy access to patient health information all in one place for access by the providers anytime, anywhere. To learn more about our services, visit Enable Healthcare.

Section 6: What Should FQHCs and RHCs Look for When Shortlisting Vendors?

When choosing a vendor for virtual care services, FQHCs and RHCs should prioritize experience, process efficiency, technology tools, privacy compliance, and reliable billing practices.

If you’re interested in learning more about how Enable Healthcare can support your practice in virtual care and chronic care management, feel free to contact us to discuss your needs and how we can help you.