Primary Care-Community Health Immersion Program in Detroit (“PC-Chip in the D”): Billing for RN Services in Michigan’s Federally Qualified Health Centers (FQHCs)

Background: Nationwide and in Detroit, Michigan, there has been a need for nurses who practice in community-based primary care teams, and as healthcare moves to the community more and more teams will need RNs working to the full scope of their license. The “PC-Chip in the D” Health Resources and Services Administration (HRSA) nurse education, practice, quality, and retention (NEPQR)-funded grant included four goals, of which one major objective was to collaboratively develop a business model to integrate RNs into community-based primary care. The primary focus for this objective was to assist our FQHCs with a business plan which acknowledged to our partners that having RNs on staff would provide a robust team care approach and enhance their revenue. Early on, we encountered a gap in knowledge related to billing for RN services amongst our FQHC partners. To move this final objective forward, our team developed a collaborative plan with multiple state level partners to enhance our teams’ as well as the FQHC staff’s knowledge in this arena.

Methods: Our grant team researched the topic as well as collaborated with other states and billing experts on billing for RN services in FQHCs. Our partnerships included a network of representatives from Michigan Institute for Care Management Transformation (MICMT), the Michigan Primary Care Association (MPCA), and the Michigan Center for Clinical Systems Improvement (Mi-CCSI) that brainstormed the best way to share information with FQHCs statewide, including information about RN billing in an FQHC environment, application to a particular site, and the nuances of billing to a variety of Medicaid plans and Medicare.

Results: The NEPQR grant team will discuss the modules/webinars that are being developed for a variety of FQHC staff audiences (e.g. chief financial officers, chief executive officers, RNs, information technology staff, etc.). Modules/live seminars are in developments and are being created by MICMT, MPCA, and the NEPQR grant teams. An example of one module is the differentiation of Medicare versus Medicaid billing for RN services in FQHCs within Michigan. Each module or live session will be 1-2 hours long with an ongoing live Q&A document. The teams will also market the projects to a variety of audiences around the state. Once these modules/webinars launch, they will be accessible to everyone free of charge through the MICMT and MPCA websites. The estimated completion date for the modules is February/March 2022.

Conclusions: In the budget-challenged environments of FQHCs and with the demand for RNs to become members of the care team, leadership teams and RNs need to learn how to generate revenue for services delivered. While RNs enhance the team, in a non-profit community-based setting like FQHCs, leaders may continue to utilize a “lower-cost” option if a revenue source cannot be secured or the value of RN care is not demonstrated. These learning sessions we are developing will assist FQHCs to learn how to bill for RN services as well as the best way to incorporate these services into the practice.