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Forward(Recorded Webinar) CMS’ 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.
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]
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Available Credit
- 1.50 Certificate of Attendance
Price
ACCESS PERIOD
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CANCELLATION POLICY
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