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November 7, 2016

Attention Rural Health Clinic (RHC) Providers!

Recent data reveals a very large number of RHC claims that are being RTP'd for Reason Code 39910. Ensure your claim billing staff and electronic vendors are aware of the recent updates to RHC billing guidelines. If you are receiving this reason code, we encourage you to fully review the claim's external narratives and pay special attention to the CMS resources below that highlights:

  • 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.

These important changes have been implemented! CGS urges you to stay abreast of the important news that directly affects your facility. Time and resources are valuable; therefore, save both by keeping up with the CMS RHC news and billing guidelines.

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