In a significant step forward for community healthcare, Medicare is implementing major changes to support Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Beginning in 2025, these essential providers will see a shift in how they bill for care coordination services—a change that promises fairer payment, greater transparency, and better support for their vital work in underserved areas.
Here’s a closer look at what this new structure means for RHCs, FQHCs, and the communities they serve.
Moving Beyond the “One-Size-Fits-All” Model
Starting in 2025, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) will transition from the general G0511 code—currently used for billing general care coordination services—to specific service-based codes for programs such as Chronic Care Management, Principal Care Management, Remote Therapeutic Management, Advanced Primary Care Management (APCM) and others. This shift represents a move toward a more precise billing system that better captures the range and complexity of care coordination services these centers provide.
Under the current G0511 code, RHCs and FQHCs receive a flat payment rate for all types of care coordination activities. This single-code system does not account for the significant variations in the level of care coordination needed for different patients, which can range from routine follow-ups to complex management of chronic conditions or multi-disciplinary care for patients with severe health issues.
The new, specific service-based codes, however, will allow RHCs and FQHCs to bill Medicare based on the specific types of care coordination services provided. This means that clinics will be able to bill at different rates depending on the complexity, duration, and resources required for each individual case. For instance, care coordination for a patient with multiple chronic conditions may be billed at a higher rate than routine check-ins, as it typically involves more intensive follow-up, coordination across multiple providers, and additional patient support.
Under the new rules, RHC and FQHC centers will not only receive standard payments but can also receive compensation for add-on services that go above and beyond typical care coordination. This update is crucial for these centers, many of which handle complex care situations requiring extra time and resources. It recognizes the essential role they play in managing multiple aspects of patient care and offers financial support to match their efforts.
Six-Month Transition Period
To ensure a smooth transition, CMS is implementing a phased approach through July 2025. This grace period gives RHCs and FQHCs time to update their billing systems, train staff, and adjust workflows to the new codes without disrupting services or causing delays in patient care. The availability for a gradual rollout is especially important for smaller clinics with limited resources to dedicate to administrative changes.
MD Revolution customers may choose to transition early in consultation with their account representatives.
Strengthening the Financial Stability of Safety-Net Providers
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are often the primary, and sometimes the only, sources of healthcare in rural and underserved areas. However, these facilities frequently operate on razor-thin margins, facing unique financial challenges due to their commitment to serving populations with high needs and limited resources. By transitioning to a payment model that accurately reflects the reality of the care coordination services they provide, Medicare is taking critical steps to support the long-term sustainability of these safety-net providers. MD Revolution supports this move enthusiastically.
Historically, RHCs and FQHCs have been constrained by a “one-size-fits-all” payment system that did not adequately compensate for the diversity and complexity of the care they deliver. Many of these centers regularly coordinate care for patients with multiple chronic conditions, mental health needs, and other complex medical issues that require intensive management and follow-up. The generic, flat-rate payment model was not only insufficient to cover the costs associated with such extensive care coordination but also left these centers vulnerable to financial strain. As a result, many safety-net providers have faced significant challenges in maintaining operations, expanding services, and investing in critical resources like staff training and facility upgrades.
The new payment structure, with specific service-based billing codes and options for add-on payments, allows RHCs and FQHCs to bill Medicare more accurately for the scope and intensity of the services they provide.
This change represents a pivotal investment in the health infrastructure of rural and underserved areas. By enabling RHCs and FQHCs to operate on a stronger financial footing, Medicare is not only supporting the sustainability of these essential providers but also ensuring that vulnerable communities maintain access to high-quality, consistent care. This reform is a crucial step toward addressing health disparities and creating a healthcare system that is both resilient and equitable.
MD Revolution Support
Our RevCare platform is already equipped to handle these new billing requirements, allowing our partners to:
- Transition seamlessly to the new codes when ready
- Maintain compliance with all new requirements
- Maximize appropriate reimbursement under the new system
- Focus on providing high-quality care while we handle the administrative complexity
Stay tuned for more updates as these changes roll out. MD Revolution’s RevCare platform is ready to transition to the updated RHC and FQHC codes to meet and exceed the requirements of the updated 2025 CMS rules. Please get in touch with your account representative or contact us with any questions.
