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Q & A: Sustainable Telehealth Solutions for CHCs

Wednesday, May 6, 2020   (0 Comments)
Posted by: Crysta Maniscalco
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Preface: This original article was created in January of 2020, prior to the COVID-19 outbreak in the United States. Many Community Health Centers (CHCs) across the nation are grappling with managing day-to-day operations during COVID-19 epidemic, now more than ever they understand the need for telehealth. In this article, you will learn about how Care Management services are able to be delivered to patients through telehealth. Not only will these services improve health outcomes for patients, these services may be crucial to ensuring the sustainability of CHCs resources in the long term. It was written that CHCs should be ensuring their foundational telehealth services are in place “sooner rather than later”, and we now all understand the scope of this statement as it relates to serving at-risk patients from the comfort of their home during the COVID-19 pandemic.

~Benjamin Lefever, Founder and CEO of Certintell



Q: What should CHCs know about the short and long term Care Management services model?

A:  CHCs can seize the opportunity to get ahead of the curve as far as laying a foundation for setting in place Value-Based Care (VBC) processes and the ability to furnish care via Telehealth. Care Management processes can incorporate telehealth, a part of the foundation every health center should be looking at sooner rather than later. Certintell helps health centers optimize these processes to improve health outcomes and empower FQHCs to properly be reimbursed for services rendered.


Q: What is the impact of changes in Care Management services CMS regulation January 1, 2019?

A: Beginning Jan. 1, 2019, CPT code 99491 will be available to bill for 30 minutes of CCM services provided by a physician or other qualified health care professional. For CCM services furnished on or after January 1, 2019, CCM services can be billed by adding the general care management G code, G0511, to an RHC or FQHC claim, either alone or with other payable services. 


Q: What do CHCs need to know about Care Management services?

A: Care Management services are vital for the most at-risk patients. These are specialized services to intervene at critical junctures of care as it relates to chronic conditions, behavioral health and when transitioning from discharge care. 


Q: What are the best practices models?

A: See CMS’s Care Management page, evidence-based service models: http://bit.ly/careMGMT


Q: What are best practices within models of quality of care in terms of closing care gaps?

A: It’s all about focusing on a patient-centered approach, individualized care plans. Many times social determinants of health (SDOH) has the largest impact on an individual’s health. Self-care is a major opportunity we see with patient-centered care: helping patients understand and learn how they can best manage their own health outcomes. Looking at chronic conditions, Springbuck® has research showing percentages of members who are compliant to care:

  1. Diabetes: 3% Member Compliance
  2. Coronary Artery Disease (CAD): 19% Member Compliance
  3. High Blood Pressure (HBP): 29% Member Compliance
  4. Cholesterol: 37% Member Compliance


Q: What are best practices in terms of revenue and pre-emptive enrollment by hospitals?

A: Every year reimbursement rates change. By proactively preparing and billing new codes you’ll stay ahead of the curve and lay a strong foundation that prepared the health center for what’s to come — this includes value-based care and the paradigm shift to telehealth. What’s more, health centers can avoid the issue where a patient can only be enrolled by one billing physician by implementing and enrolling patients into Care Management services before other local centers do.


Q: What is the enhanced reimbursement rate?

A:  A couple examples include ability for CHC providers to bill from Chronic Care Management at a rate of about $67 where a private clinician would be around $42 and they can also deliver Annual Wellness Visits for scheduled patients at a rate of 1.34 times the PPS rate. Health centers need to talk with their CFO or billing specialists regarding additional services.


Q: How does Certintell interpret the CONNECT for Health Act and its impact on telehealth? 

A: The act expands the ability to deliver services to Medicare beneficiaries through telehealth. Currently, outside of special guidelines due to COVID-19, only Medicare beneficiaries in rural areas have access to care through telehealth. 


Q: What is the specific impact of the CONNECT for Health Act on CHCs?

A: From the bill, “With regard to individuals with certain chronic conditions, telehealth services shall be covered under Medicare as medical and other health services, rural health clinic services, or federally qualified health center (FQHC) services, as the case may be.”


Q: What are the existing vulnerabilities around Care Management services, transition, enrollment, dual eligibility, billing?

A: There are many areas that make it difficult for community health centers to deliver Care Management services via telehealth. These can be complex services to build a process for and execute, allowing referral networks and partner companies to work with CHCs to support this issue. Billing for Medicare and Dual-eligible beneficiaries is available for Care Management Services.


Q: How does this Care Management services telemedicine program prepare CHCs for upcoming changes due to value-based care?

A: Proper delivery of Care Management services improves outcomes for Medicare and Dual-eligible beneficiaries, one step in the right direction for value-based care. CHCs will begin to see more and more patients wanting care via telehealth solutions, giving them instant access to patients that need care in order to improve health outcomes.


Q: What data indicates that CHCs actually need more Medicare patients?

A: CHCs aren’t able to keep up with the current workload of Medicare patients — less than 25% of patients are receiving their AWVs for example. Medicare beneficiary numbers will only grow through the next 10 years and Telehealth can support the workforce demands. Additionally, there are significant enhance payment options for CHCs that they may not be aware of for Medicare patients.


Q: What should CHCs know about dual eligibility (Medicaid/Medicare eligible)?

A: Duals are some of the highest at-risk populations. Many times a co-pay isn’t required, lowing the barriers for the patient to enroll into Care Management services. 


Q: How do CHCs leave money on the table? What revenue is left on the table?

A: There are many health services that CHCs are delivering but aren’t billing for, including Chronic Care Management and Remote Patient Monitoring to name only two. CHCs are stretched thin which doesn’t allow them to deliver additional services like CMS’ Care Management which are needed by many patients. Not only are these services a significant opportunity to improve health outcomes for patients but also a significant revenue opportunity as well.


Q: How are we losing patients to other competitors?

A:  If CHC patients are enrolled at another health care facility for Care Management services, the patients are no longer eligible to be enrolled at the CHC unless they first tell the other billing provider’s office to unenroll them.


Q: Do you have data that identifies where CHCs are losing patients through other competitors?

A: This specific data can be determined when a CHC partners with Certintell, then Certintell can run eligibility reports for the CHC’s whole patient population to determine which patients may be enrolled in Care Management services already.


Q: What is the 2024 closing window of opportunity for Medicaid enrollment?

A: CMS has made it clear VBC will become the priority for the future with their deadline of 2024. CMS has made it clear that FFS may be phased out in the future as a general goal. Working with Payers, this VBC data is going to be crucial for CHCs to thrive.


Q: What ICD-10 billable codes are CHCs unaware of or not using for Care Management services?

A:  CHCs are aware of their ICD-10 codes but what they may not be as aware of is how to tie those codes to Care Management services. For example, patients with 2 or more chronic conditions may be eligible for Chronic Care Management, but CHCs may not be aware that Seasonal Allergies is considered a chronic conditions and can all be supported through Care Management services with the addition of 1 or more other chronic conditions. There is an exhaustive list of chronic conditions applicable for patients to benefit from Chronic Care Management. 


Q: How can CHCs use Code 4 – Advanced Care Planning (99497, 99498) codes with the Certintell Care Management services telehealth program?

A:  Certintell’s clinical staff can support the delivery and care coordination of ACP for community health center patients.


Q: What advantages or benefits does the Certintell Care Management services program offer compared to other Care Management services programs?

A: Certintell Telehealth follows the modalities of delivery as defined by The Center for Connected Health Policy (CCHP), a program of the Public Health Institute. CCHP is a nonprofit, nonpartisan organization working to maximize teleheath's ability to improve health outcomes, care delivery and cost effectiveness. Many competitors ONLY deliver care management over the telephone which is a much less valuable form of engagement when compared to synchronous video and even messaging. CCHP also outlines Remote Patient Monitoring as a requirement of Telehealth, which many competitors don’t offer but Certintell does: https://certintell.com/solutions/remote-patient-monitoring/


Q: What benefits do other Care Management services approaches offer?

A: There are other companies supporting the delivery of Care Management services. Some have registered nurses, some have remote staff all across the US interacting with patients and many only support care coordination with patients over the telephone (telephonic). Some even mention that they deliver care via telehealth but they aren’t actually delivering services based on CCHP’s definition of telehealth. We would be more than happy to go over more details and point out some major differences, schedule a no-obligation overview today and better understand why Certintell is positively different.


Q: If CHCs don’t have the bandwidth to accomplish the 20 minute minimum for each medicare/Medicaid patient, how does Certintell – as an external partner - ensure that 20 minute minimum is met each month?

A: Certintell employs Health Coaches with their Certificate of Competency as a Clinical Health Coach. They are trained on how to improve outcomes for patients through the optimized process and planning revolving around patient-centered care and Care Management services. Time is accurately tracked with reports available to all partnering community health centers for each patient and service delivered. Benefits of the Certintell Care Management services:


Q: How do CHCs know the Certintell staff is certificated?

 Certintell can provide references regarding each Certintell Health Coach’s Certificate of Competency as a Clinical Health Coach. This training has proven its impact with more than 3,000 healthcare professionals in hundreds of organizations. Built and continuously refined in the clinical setting it provides focused, high-performance skills which inspire patients and accelerates healthcare team effectiveness.


Q: What is the Certintell health coach turnover?

A: Zero!


Q:  What do CHCs need to know after they have signed up?

A: Certintell is truly working with CHCs as a partner. A single point of contact is selected at the CHC and Certintell’s account coordinators work directly with them to ensure training, onboarding and execution of services is completed in relation to clinic workflows. 


Q: How does Certintell overcome the patient boredom with telehealth?

A: Enabling engagement through video or messaging has a multiplier effect to ensure Certintell Health Coaches have access and proper attention of the patient.


Q: What tools do you provide for the transition from Care Management to Chronic Care Managment?

A: Telehealth platform is furnished, along with Time-tracking and Reporting software. 


Q: Can Certintell provide data supporting the claim of positive impact from the Care Management services telehealth model?

A: Case studies are currently being built, with many ongoing programs happening in Louisiana and North Carolina. 


Q: Are CHC early adopters or entrepreneurial?

A: Community health centers are being proactive by implementing telehealth and, separately, improving patient health outcomes through Care Management Services.


Q: What does putting the Certintell Care Management services model into place look like from a CHC point of view?

A: These programs are fully funded by CMS, they’re here for the long run. Certintell partners with CHCs to work in parallel with their clinical workflows to improve patient outcomes and because a long-term sustainable telehealth solutions for the clinic.


Q: How do CHCs know that this program will be around over the long term?

A: VBC is just getting started and CMS is adding more programs year after year.



To get more information and to talk directly with Certintell staff, schedule a no-obligation overview here. You can also reach us at 1-800-946-9143 or via email at info@certintell.com






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