Telehealth Triumph: Strategies for FQHCs to Optimize Revenue Streams

As an FQHC leader, you likely know that adapting to the evolving healthcare landscape is so important, and making sure your FQHC is capturing all possible revenue from telehealth services is crucial. 

By utilizing telehealth, your FQHC can effectively expand its reach, improve patient outcomes, and optimize its revenue streams. Telehealth also enables your FQHC to enhance efficiency by reducing no-show rates, offering more convenient appointment scheduling, and providing cost-effective care delivery. Overall, embracing telehealth technologies empowers your FQHC to better serve your communities and fulfill your mission of providing accessible, high-quality healthcare to all. 

So, what does it look like to optimize telehealth revenue? To ensure that your FQHC is capturing all possible revenue from telehealth services, consider the following strategies and technologies:  

Telehealth Reimbursement Strategies

Understand Payer Policies: It's crucial for your FQHC to have a thorough understanding of telehealth reimbursement policies from Medicaid, Medicare, and private insurers. These policies can vary significantly, especially in terms of covered services, eligible providers, and payment parity between in-person and telehealth visits. Here are some different approaches to payers in the game: 

• Medicaid and Medicare Telehealth Billing: Ensure that your FQHC is billing for all eligible telehealth services under Medicare and Medicaid guidelines. FQHCs can bill for telehealth under Medicare's Prospective Payment System (PPS) as long as services meet the guidelines (e.g., use of real-time audio-video communication). 

• State-Specific Medicaid Policies: Some states have specific telehealth billing requirements, including which providers can deliver services and which services qualify for reimbursement. Your FQHC should stay informed about any temporary or permanent telehealth policy changes, especially in Medicaid expansion states. 

• Payer Parity: Advocate for and capitalize on states or payers that have telehealth payment parity laws, ensuring that telehealth services are reimbursed at the same rate as in-person services. 

Document and Code Correctly: Proper coding is essential to ensure full reimbursement for telehealth services: 

• Use Appropriate Telehealth Modifiers: Ensure that telehealth claims include the appropriate modifiers and place-of-service codes. For example, use the "02" modifier for telehealth or other modifiers required by specific payers. 

• Billing for Audio-Only Visits: In many states, audio-only telehealth visits are reimbursable, especially for behavioral health. Ensuring proper documentation and billing for these visits can enhance revenue. 

• Track Denied Claims: Your FQHC should have a system in place to monitor claim denials related to telehealth services, quickly identifying and correcting any patterns that lead to underpayment or denial. 

Improving the Payer Mix

Expand Private Insurance and Medicare Billing: Although Medicaid is typically the main payer for FQHCs, reaching out to patients with private insurance or Medicare can help diversify revenue streams. Some private payers and Medicare Advantage plans offer better telehealth reimbursement, so focusing on these patient groups may boost overall revenue. 

Contract Negotiations with Managed Care Organizations (MCOs): Your FQHC should negotiate contracts with Medicaid MCOs to ensure that telehealth services are included and reimbursed at favorable rates. Additional contract addendums or amendments may be necessary to encompass telehealth services fully. 

Enhance Telehealth Infrastructure

Invest in Secure Telehealth Platforms: Ensure that the FQHC uses a telehealth platform that complies with HIPAA and state regulations. The platform should offer: 

• High-Quality Video and Audio: A reliable platform that ensures high-quality, real-time audio and video communication is crucial. Poor-quality services can lead to patient dissatisfaction and a potential decline in utilization. 

• Integrated EHR/EMR Solutions: A telehealth platform that integrates seamlessly with your FQHC's electronic health record (EHR) or electronic medical record (EMR) system ensures that patient records are updated automatically, improving billing accuracy and reducing administrative burdens. 

• Scalability: The platform should be scalable to handle increasing demand without compromising service quality. 

Technology for Remote Patient Monitoring (RPM): 

• Use RPM for Chronic Care Management: Investing in remote monitoring technologies allows your FQHC to provide chronic care management services remotely. RPM can track your patients' vitals, like blood pressure and glucose levels, and transmit data to your healthcare team, enhancing care for chronic conditions and enabling billing for additional services. 

• Integrated Data Analytics: Tools that provide real-time analytics and reporting on patient health can help ensure early intervention and prevent costly hospitalizations while also qualifying for value-based payment incentives. 

Mobile Health Applications: Offering patients mobile apps that allow for appointment scheduling, telehealth visits, and communication with providers can enhance engagement and increase telehealth utilization, thereby increasing revenue. 

Help Patients Use Telehealth Services to the Fullest

Educate Patients: Since many FQHC patients may not be familiar with telehealth, we can provide education through webinars, phone calls, social media, or even physical flyers in the clinic. This will help them understand how to access telehealth services, when to use them, and the advantages of virtual care. 

Leverage Text Messaging and Patient Portals: Utilize patient engagement technologies like text messaging and patient portals to send reminders, promote telehealth visits, and keep patients engaged in their care. Many FQHC patients may not have regular internet access, so leveraging mobile-friendly communication methods is crucial. 

Diversify Telehealth Services

Behavioral Health Services: When considering diversifying telehealth services, it's important to note that telehealth has shown to be highly effective for behavioral health services. Many Medicaid programs also reimburse for these visits. Expanding tele-mental health services has the potential to enhance patient outcomes and increase revenue. 

Chronic Disease Management and Preventative Services: Telehealth can be used effectively for managing chronic conditions, like diabetes and hypertension, as well as providing preventative care services, such as nutritional counseling and smoking cessation. These services often qualify for reimbursement and align with value-based care models. 

Specialty Care via Telehealth: Offering specialty services such as dermatology and endocrinology via telehealth, either through partnerships or directly, can help minimize referral delays and boost revenue. 

Staff Training and Workflow Integration

Train Providers on Telehealth Best Practices: You should be making sure that your providers are comfortable with telehealth technology, and if that is the case, workflows will enhance patient care and ensure accurate billing. This includes appropriate use of documentation and coding practices for telehealth services. 

Establish Clear Telehealth Workflows: Let's set up straightforward workflows for our staff, including those at the front desk, billing teams, and clinical providers. By streamlining scheduling, patient check-in, and documentation processes for telehealth, we can work more efficiently and seize more billing opportunities. 

Offer Hybrid Visits: In cases where a telehealth visit might not suffice, offering hybrid visits (where part of the visit happens in-person and part remotely) can optimize care while capturing reimbursement for both types of visits when applicable. 

Monitor Financial Performance and ROI

Keep an Eye on Telehealth-Specific Metrics: Use analytics tools to track telehealth utilization, reimbursement rates, claims success rates, and patient satisfaction. Monitoring these metrics can help identify areas for improvement and ensure that telehealth services are contributing positively to your FQHC's financial performance. 

Maximize Incentives from Value-Based Care Programs: Many value-based care programs, including the Medicare Shared Savings Program (MSSP) and Medicaid managed care plans, reward FQHCs for improving outcomes. Telehealth can help your FQHC meet the metrics required to receive these payments, such as reducing hospital readmissions or improving chronic care management. 

By leveraging the right technology, optimizing billing practices, and integrating telehealth into everyday workflows, your FQHC can ensure that you are maximizing your revenue from telehealth services while continuing to provide high-quality care to underserved populations. It's a win-win! Contact Synergy Billing today to see how we can help you optimize your revenue streams.

Check out all our Blogs and Insights HERE

BOOK A DISCOVERY CALL TODAY