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ForwardCMS’ CY2025 Medicare Physician Fee Schedule Final Rule: What FQHCs Need To Know
FQHCs can expect significant Medicare changes in 2025. The Centers for Medicare & Medicaid Services’ (CMS’) Calendar Year (CY) 2025 Physician Fee Schedule Final Rule, published on December 9, 2024, announced new payment and coverage policies that will create new opportunities for FQHCs. The publication of the CY2025 final rule is an optimal opportunity reevaluate your health center’s Medicare strategy.
Key provisions in the final rule include the following. Please note that some of these changes will be implemented by CMS effective July 1 (rather than January 1), 2025, in order to allow CMS and providers sufficient implementation time.
- Care management services. FQHCs will have the opportunity to furnish and be paid for Medicare advanced primary care management (APCM) services—a more comprehensive approach to primary care targeted to individuals with greater clinical needs—and to receive additional payments for use of the APCM model. FQHCs and rural health clinics (RHCs) will also be required to bill Medicare for care management services using detailed HCPCS codes rather than the bundled G code that FQHCs/RHCs have up to present used on Medicare care management claims.
- Vaccines and physician-administered medications. FQHCs will be eligible for the first time for interim payment on a fee schedule basis for the costs of influenza, pneumococcal, COVID-19, and hepatitis B vaccines and the costs of administering those vaccines. Please note that these new payments will be on an interim basis only; final payment will be made (as is present practice) through the settlement of each FQHC’s cost report. Separate payment will also be made available for the first time to FQHCs under Medicare Part B for pre-exposure prophylaxis (PrEP) for HIV prevention.
- Dental visits. CMS has recognized that FQHCs may be paid under the FQHC PPS for certain dental services that are inextricably linked to medical services. CMS will create a new FQHC visit type to correspond to dental visits, and the regulations will allow for a Medicare dental visit and medical visit to be billed on the same day.
The webinar will also cover other areas addressed in the PFS final rule, including policy surrounding telecommunications-based services in FQHCs—an area where CMS’ proposals for CY2025 will not feature any significant change in requirements, coverage or payment.
The on-demand version of this webinar will be available for purchase after the conclusion of the live webinar.
Target Audience
- C-Suite
- Billing Managers
- Clinical Practice Managers
- Revenue Cycle Managers
Learning Objectives
After this webinar, you will be able to:
- Explain the key provisions and associated opportunities for FQHCs in the Medicare CY 2025 Proposed Physician Fee Schedule Final Rule
- Understand the scope of upcoming service expansions and changes in billing and payment requirement
- Evaluate how your FQHC or RHC will implement the changes
Susannah Vance Gopalan
Susannah Vance Gopalan is a Partner in the firm’s Health Care practice group where she focuses on health care litigation and regulatory counseling, with a focus on Medicaid and Medicare payment, financing, and compliance issues. She brings regulatory experience to bear when advising clients and pursuing litigation on their behalf. She has a record of negotiating Medicaid waivers and managed care arrangements on behalf of providers, provider associations, and governmental entities. She represented a group of providers in reaching a settlement in major Medicaid litigation. [Full Bio]
Participants can earn up to 1.80 CPE credits in Specialized Knowledge and Applications upon completion of all course requirements.
ATTENDEE REQUIREMENTS FOR CPE CREDIT
If you purchase CPE credit for this webinar you must satisfy the following conditions in order to receive your certificate:
- Answer at least 6 of the polling questions during the webinar
- Complete the evaluation survey after the conclusion of the webinar or in the follow-up email
Upon completion of these requirements, we will email you your CPE Certificate within two (2) weeks.
ADDITIONAL INFORMATION
- Prerequisites: None
- Target Audience: C-Suite, Billing Managers, Clinical Practice Managers, and Revenue Cycle Managers
- Advanced Preparation: None
- Program Level: All
- Delivery Method: Group Internet Based
- Attendance Requirements: In order to be awarded the full credits, you must respond to six (6) out of eight (8) polling questions.
Feldesman Leifer LLP is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website www.nasbaregistry.org (formerly www.learningmarket.org).
Available Credit
- 1.50 Certificate of Attendance
- 1.80 CPEFTLF is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors.
Price
Access to the recorded version of this webinar is included in your purchase.
You will have access to the recordings for 180 days after enrollment. Once posted to your account, you can view each webinar anytime on-demand during the access period identified in your purchase confirmation. For additional information on viewing and accessing webinars, view our full terms and conditions here.
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