A person tests their blood glucose levels using an RPM device.

2024 CMS RPM Reimbursement for FQHCs and RHCs

In the final rule of the 2024 Medicare Physician Fee Schedule, released on November 2, 2023, Medicare announced two major changes that will greatly benefit Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). While one change may not be as well received as the other, the net effect of these revisions is overwhelmingly positive, promising a brighter future for these providers and the communities they serve.

The following is a review of the “pros” and “cons” of the final rule as it relates to FQHCs and RHCs.

Pro #1: Reimbursement for Remote Patient Monitoring

Perhaps the most significant change is the confirmation that Medicare will finally start reimbursing FQHCs and RHCs for remote patient monitoring (RPM). Starting January 1, 2024, providers will be eligible to bill for two remote health monitoring services under the general care management code G0511, at a rate of $72.98 per patient per month. FQHCs and RHCs can provide and bill for both services to the same patient in the same month.

These services include:

  • CPT 99454: Reimburses for the use of smart-enabled remote patient monitoring systems that transmit biometric readings to a digital platform. The patient must transmit at least 16 days of readings in a 30-day period.
  • CPT 99457: Reimburses for 20 minutes of clinical staff time spent monitoring and coordinating care for an RPM patient, including live interaction with the patient.

Pro #2: Multiple Billing for G0511

The final rule also confirms that FQHCs and RHCs can bill G0511 multiple times per month for the same patient, provided that the minimum requirements are met for each subcategory code. This means that technically, an FQHC could bill G0511 multiple times for all subcategory codes, for the same patient in the same month. In practice, a provider might bill G0511 four times for one patient in the same month, covering RPM, chronic care management (CCM), and behavioral health integration (BHI).

Con: Reduction in G0511 Reimbursement Rate

While CMS has updated the rule to reflect multiple billing for G0511, there is a reduction in the reimbursement rate from $77.94 in 2023 to $72.98 in 2024. However, this reduction should be seen in the context of the overall positive impact these changes will have on providers and their patients, including improved access to important services like RPM and BHI, in addition to CCM.

How the CMS 2024 Rule Impacts FQHCs and RHCs

These changes empower FQHCs and RHCs to take a holistic approach to patient care, no longer forced to choose between real-time monitoring and long-term management of chronic conditions. The potential for providers to earn over $300 per patient per month through various billing codes for CCM, RPM, and BHI will greatly support providers in delivering enhanced patient care.

For providers currently relying on grants to fund RPM programs, this new reimbursement model offers a sustainable means to continue these programs. And for providers that previously couldn’t afford to participate in RPM, this is an exciting opportunity to expand their services, potentially earning $440,000 for every 500 patients enrolled in an RPM program.

Remote Monitoring’s Impact on Patients

Remote patient monitoring allows patients to conveniently track their health from the comfort of their homes while enabling timely interventions to prevent hospitalization and ER visits. The monitoring of vital signs has shown to improve health outcomes, including better control of blood pressure and A1c levels.

These changes also increase patients’ access to behavioral health services, potentially improving the management of conditions like depression, anxiety, and substance use. This holistic approach to care empowers providers to address the needs of the “whole person.”

TimeDoc Helps Providers Elevate Care and Boost Revenue Amid RPM Reimbursement Changes

TimeDoc Health is the largest virtual care management provider for FQHCs and is well-positioned to support a smooth transition through these changes. Our solution, intentionally designed to support Medicare, Medicaid, and dual-eligible patients, encompasses CCM, RPM, and BHI, helping FQHCs and RHCs enhance patient outcomes.

The 2024 RPM reimbursement changes represent a significant step forward for providers, enabling them to provide more comprehensive and accessible care to their patients. With the potential for increased revenue and improved patient outcomes, FQHCs and RHCs are better equipped to deliver the high-quality healthcare services they have long aspired to provide.

To learn more about how TimeDoc Health can help, contact us.