Did You Know? – Rural Health Clinic
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- I do not understand RTP Reason Code 39910. Have there been recent changes to RHC billing requirements?
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The following are the current guidelines:
- Required HCPCS reporting from the RHC Qualifying Visit List
- Changes to reporting specific codes, and
- The submission of the CG modifier to the line with all the charges subject to coinsurance and deductible.
References:
- MLN Matters® article MM9269
- MLN Matters® article SE1611
- Rural Health Clinics (RHCs) Reporting Requirements Frequently Asked Questions (FAQs) (Revised 10-14-16)
- CMS Rural Health Clinic Center Website - Spotlights
Reviewed 12/02/2022
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- Do rural health clinics bill the Part A for influenza and PPV vaccinations?
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The following are the current guidelines:
- Rural Health Clinics - Influenza and Pneumococcal Vaccine Administration and Payment - The cost of the influenza and pneumococcal vaccines and related administration are separately reimbursed at annual cost settlement. There is a separate worksheet on the cost report to report the cost of thesevaccines and related administration. These costs should not be reported on a RHC claim when billing for RHC services. The patient pays no Part B deductible or coinsurance for these services. When a RHC practitioner (e.g., a physician, NP, PA, or CNM) sees a patient for the sole purpose of administering these vaccinations, the RHC may not bill for a visit; however, the costs of the vaccines and their administration are included on the annual cost report and reimbursed at cost settlement.
References:
Reviewed 12/02/2022
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- Does CMS conduct Open Door Forums regarding RHCs?
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Yes. For information and schedules go to CMS Rural Health Open Door Forum website
Reviewed 12/02/2022
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- Can RHCs bill for Chronic Care Management (CPT 99490)?
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Effective January 1, 2016, RHCs and FQHCs shall be paid for CCM services furnished to patients with multiple chronic conditions that are expected to survive at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
Claim submission and specific CCM guidelines are available in CMS Change Request (CR) 9234: Chronic Care Management (CCM) services for Rural Health Clinics (RHCs) and Federal Qualified Health Centers (FQHCs)
Reviewed 12/02/2022
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- Where can I find RHC information on the CMS website? Is there a dedicated website?
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CMS has a dedicated RHC website that contains payment information, updates and more.
Reviewed 12/02/2022
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- Are there new billing instructions for RHCs in 2016?
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Effective April 1, 2016, RHCs, including RHCs exempt from electronic reporting under Section 424.32(d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code, and other required billing codes. Payment for RHC services will continue to be made under the All-Inclusive Rate (AIR) system when all of the program requirements are met. There is no change to the AIR system and payment methodology, including the "carve out" methodology for coinsurance calculation, due to this reporting requirement.
In addition, the submission of the CG modifier to the line with all the charges subject to coinsurance and deductible is required.
Reference:
Reviewed 12/02/2022
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- Do rural health clinics bill the Part A for influenza and PPV vaccinations?
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Rural Health Clinics – Influenza and Pneumococcal Vaccine Administration and Payment – The cost of the influenza and pneumococcal vaccines and related administration are separately reimbursed at annual cost settlement. There is a separate worksheet on the cost report to report the cost of these vaccines and related administration. These costs should not be reported on a RHC claim when billing for RHC services. The patient pays no Part B deductible or coinsurance for these services. When a RHC practitioner (e.g., a physician, NP, PA, or CNM) sees a patient for the sole purpose of administering these vaccinations, the RHC may not bill for a visit; however, the costs of the vaccines and their administration are included on the annual cost report and reimbursed at cost settlement.
Reviewed: 12/02/2022
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- I received a remit for a negative amount. What does this mean? Do I owe Medicare for some reason?
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Negative reimbursement is when cost of the service(s) is more than the all inclusive rate for the provider and the billed amount is applied to the beneficiary's deductible.
Total Bill $120
AIR for Provider $80
Beneficiary's responsibility $120
Medicare Reimbursement -$40There is no action required by the provider in this situation.
Reviewed: 12/02/2022
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