By: Rupalakshmi Vijayan, MD, MS and Jill Haltigan, MD
Family physicians across Ohio are seeing a growing number of patients who delay or avoid care because of fear, particularly concerns related to immigration status, confidentiality, cost, or broader mistrust of institutions. These fears can lead to deferred preventive services, poorly controlled chronic disease, and avoidable emergency department visits.
At the same time, physicians must balance compassionate access with the financial realities of running a practice. The good news is that tools exist to help practices reach vulnerable patients while ensuring appropriate payment for the complex, longitudinal care they provide.
This article outlines practical strategies physicians can implement now, along with key resources from the American Academy of Family Physicians (AAFP) that support both care delivery and reimbursement.
Expanding Access Through Optimized Telehealth
For patients who are hesitant to visit a medical office, Telehealth offers a critical bridge. Whether concerns stem from immigration-related fears, transportation barriers, or anxiety about interacting with systems, virtual care can provide a more comfortable entry point.
- Improving pre-visit technical support so patients can connect successfully
- Training staff to proactively explain what to expect during virtual visits
- Integrating telehealth scheduling seamlessly into routine operations
- Promote telehealth options through patient portals, websites, and reminder systems.
By strengthening telehealth infrastructure, practices can maintain continuity of care and reduce missed appointments among patients who might otherwise disengage.
Reinforcing Confidentiality and Building Trust
Fear often stems from misunderstandings. Many patients are unsure how their information is used or whether their immigration status could be disclosed. While physicians understand HIPAA protections, patients may not be able to.
- Clearly explain confidentiality protections during registration and intake
- Display visible statements about patient privacy and rights
- Provide language-appropriate materials and interpreter services
- Train front desk and clinical staff in culturally responsive communication
- Offer flexible payment options to ensure access to care within a non-profit healthcare system.
Proactively addressing privacy and cost concerns at the scheduling stage can significantly increase follow-through on appointments. For many patients, reassurance is as important as treatment.
Getting Paid for Longitudinal Care: Understanding the Add-On Code G2211
Caring for patients who require additional reassurance, coordination, and relationship-building often involves cognitive work that extends beyond a standard office visit. Medicare’s add-on code G2211 was created to recognize the complexity inherent in serving as the continuing focal point for a patient’s care.
The AAFP’s recent update on G2211 with an infographic provides important clarification for 2025 and beyond. The code can be reported in conjunction with appropriate evaluation and management (E/M) services when the visit reflects ongoing, comprehensive care. Notably, Medicare now allows payment for the G2211 add-on code even when the associated E/M service requires modifier 25 in certain circumstances, expanding appropriate reporting opportunities.
- Managing multiple chronic conditions
- Addressing psychosocial barriers affecting care adherence
- Coordinating community services
- Providing ongoing preventive and longitudinal management.
While commercial payer policies vary, many Medicare Advantage plans have begun recognizing the code when requirements are met. Reviewing documentation practices and billing workflows can help ensure appropriate use.
Leveraging Advanced Primary Care Management Opportunities
Beyond the G2211 add-on code, Medicare continues to expand support for primary care through Advanced Primary Care Management (APCM) and related care management services. These payment models recognize the work that occurs between visits, including outreach, care coordination, and chronic disease management.
For patients hesitant to seek in-person care, structured outreach and follow-up can be essential to maintaining engagement. APCM and related codes may help offset the administrative and clinical time required for that outreach.
You are encouraged to review current Medicare guidance and evaluate whether your practice infrastructure supports implementation of these services.
Creating a Welcoming Practice Environment
Access is not solely about payment or technology. The physical and cultural environment of a practice can significantly influence whether patients feel safe seeking care.
- Posting multilingual signage explaining privacy protections
- Offering printed materials that clarify insurance and payment options
- Partnering with trusted community organizations that serve immigrant populations
- Utilizing team-based care to conduct follow-up outreach.
Small operational changes can collectively strengthen patient confidence and continuity.
Moving Forward Together
Family physicians are uniquely positioned to provide relationship-centered, continuous care, especially for patients navigating fear or uncertainty. By combining thoughtful communication, optimized telehealth systems, and appropriate use of payment tools, such as the G2211 add-on code and advanced care management services, practices can expand access while maintaining financial sustainability.
The resources developed by the AAFP offer timely support in both care delivery and reimbursement strategy. As healthcare challenges evolve, clinicians can continue to lead with compassion, innovation, and practical stewardship of their practices.
- https://www.aafp.org/family-physician/practice-and-career/managing-your-practice/telehealth-and-telemedicine/telehealth-optimization-tips.html
- https://www.aafp.org/pubs/fpm/issues/2025/0100/g2211-update.html
- Olkaba, H. (2024). Billing G2211 for Evaluation and Management of Your Complex Patients. ASA Monitor, 88(4), 30
- https://www.cms.gov/priorities/innovation/about/cms-innovation-center-strategy-make-america-healthy-again.