Telehealth Reimbursement Challenges in 2024: What CHCs and FQHCs Need to Know
Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs) play a crucial role in providing healthcare to underserved populations. With the expansion of telehealth services during the COVID-19 pandemic, many of these organizations have continued embracing virtual care. However, as we approach the end of 2024, significant challenges around telehealth reimbursement are emerging, posing concerns for medical billing and the financial sustainability of these centers.
The Looming Expiration of Telehealth Flexibilities
The Consolidated Appropriations Act of 2023 temporarily extended telehealth flexibilities for CHCs and FQHCs until December 31, 2024. This extension enabled audio-visual and audio-only telehealth services to be reimbursed at the same rate as in-person visits. This policy was a lifeline for organizations serving patients with limited access to in-person care, especially in rural areas.
At the end of July 2024, the Centers for Medicare & Medicaid Services (CMS) proposed to extend a number of COVID-era regulatory flexibilities related to telehealth, remote services, and supervision in the CY 2025 Medicare Physician Fee Schedule (PFS) Proposed Rule for an additional year. However, unless further legislation is enacted, these payment rates are set to expire, raising concerns about reduced revenue for telehealth services. As telehealth has become integral to care delivery, CHCs and FQHCs must prepare for potential cuts in reimbursement. Recent efforts by lawmakers to extend telehealth flexibilities further indicate a strong desire to preserve these services, but financial uncertainty remains a pressing issue.
State-Level Reimbursement Variations
Several states have made strides toward permanent Medicaid telehealth reimbursement policies, particularly for behavioral and mental health services. For instance, states like Texas have expanded eligibility for telemonitoring services, making it easier for providers to get reimbursed for remote patient monitoring. However, disparities still exist in how private payers handle telehealth. While states like Nevada have mandated payment parity for telehealth and in-person services, other states still offer lower reimbursement for audio-only services, disproportionately impacting CHCs and FQHCs providing care to patients without access to video technology.
Impact on Medical Billing Operations
The changing telehealth landscape has significant implications for medical billing. As telehealth evolves, so must the billing practices that support it. Medical billing teams face the challenge of staying current with state and federal reimbursement policies, negotiating contracts with payers, and ensuring compliance with new coding requirements. Failure to adapt could lead to denied claims and revenue loss, further stressing the already limited financial resources of CHCs and FQHCs.
How CPa Medical Billing Supports CHCs and FQHCs
At CPa Medical Billing, a GeBBS Healthcare company, we understand the unique challenges CHCs and FQHCs face in navigating complex billing environments, particularly in light of shifting telehealth policies. Our outsourced medical billing services are designed to help healthcare organizations maximize revenue while reducing administrative burdens.
Expertise in Telehealth Billing
Our team specializes in telehealth billing, ensuring that your claims are coded correctly and comply with the latest federal and state regulations. We stay ahead of legislative changes, so you don’t have to worry about sudden shifts in reimbursement rates or evolving payer requirements. Our proactive approach ensures timely and accurate submission of telehealth claims, reducing the risk of denials and delays in payment.
Denial Management and Revenue Optimization
In addition to telehealth expertise, CPa Medical Billing offers comprehensive denial management services. With the anticipated expiration of telehealth payment parity, we focus on identifying patterns in claim denials and addressing them at the root cause. Our data-driven approach can improve your clean claim rate by 10-15%, directly impacting your cash flow and operational efficiency.
Tailored Solutions for CHCs and FQHCs
We recognize that CHCs and FQHCs often operate on tight margins and rely heavily on Medicaid and Medicare reimbursements. Our services are customized to meet your organization’s specific needs, from handling complex payer mixes to managing the intricacies of telehealth billing. By outsourcing your medical billing to CPa, you can focus on what matters most—providing high-quality care to your patients.
Looking Ahead
As the expiration of telehealth flexibilities looms, CHCs and FQHCs must act now to safeguard their financial health. Partnering with an experienced revenue cycle management and medical billing company like CPa Medical Billing can make all the difference in navigating these challenges. Whether through optimizing telehealth billing, managing denials, or adapting to evolving reimbursement landscapes, we support your organization’s long-term sustainability.
Sources:
- NIH:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035352/#:~:text=A%20national%20study%20including%2036,interactions%20in%20the%20same%20period.
- GovInfo: https://www.govinfo.gov/app/details/PLAW-117publ328
- org: https://telehealth.org/telehealth-reimbursement-2024/
- AMA: https://www.ama-assn.org/practice-management/digital/bill-extend-telehealth-flexibilities-clears-house-committee