Provider Alert! Telemedicine and Telehealth Benefit Updates for Rural Health Clinics and Federally Qualified Health Centers Effective November 1, 2023

Date: November 7, 2023

Attention: Rural Health Clinics and Federally Qualified Health Centers

Effective date: November 1, 2023

Call to action: The purpose of this communication is to provide guidance on the implementation of a new telehealth patient site facility fee benefit for federally qualified health center (FQHC) and rural health clinic (RHC) providers.

How this impacts providers: Effective for dates of service on or after November 1, 2023, FQHC and RHC providers performing patient-site telehealth services may be reimbursed for the facility fee (procedure code Q3014) as an add-on procedure code.

Procedure code Q3014 will be a benefit for FQHC and RHC providers when telehealth services are rendered in the office or outpatient hospital setting.

Additional information:

• For FQHCs-the facility fee should not be included in any cost reporting that is used to calculate a prospective payment system (PPS) or alternative prospective payment system (APPS) per visit encounter rate.
• For RHCs-the facility fee should not be included in any cost reporting that is used to calculate the RHC All Inclusive Rate (AIR) PPS per visit encounter rate.
• More than one facility fee for the same client on the same date of service may be reimbursed for multiple distant-site provider consultations, when medically necessary.
• If an FQHC or RHC is eligible for the payment of both an encounter fee and a facility fee for the same client on the same date of service, the FQHC or RHC must submit a claim for the facility fee separately from the claim that was submitted for the encounter.
• Clarifications for telemedicine and telehealth include that FQHC practitioners may be employees of the FQHC or contracted with the FQHC. In addition, RHC practitioners may be employees of the RHC or contracted with the RHC.
• Furthermore, a distant-site provider that is located outside of state lines while rendering services is considered to be an out-of-state provider.
• Texas Children’s Health Plan (TCHP) must reprocess affected claims submitted with this procedure code as a telehealth service and date of service on or after November 1, 2023.

Next step for Providers: Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete. Providers may bill TCHP retroactively for procedure code Q3014.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.