How do I become a Rural Health Clinic?
Becoming an Rural Health Clinic is a process that requires program certification and specific procedures. Health Services Associates has the necessary knowledge and tools to assist you in becoming a RHC.

What is a Medicare cost report?
The Medicare Cost Report (MCR) is an annual report required of all institutions participating in the Medicare program. The MCR records each institution's total costs and charges associated with providing services to all patients, the portion of those costs and charges allocated to Medicare patients, and the Medicare payments received.

Billing Questions

Where do Flu/pneumonia shots get billed - for Medicare and Medicare HMOs?
Straight Medicare - Shots do not get billed, but get log filed with your cost report.
Medicare HMOs - Bill the individual HMO on a HCFA1500

Where do billing Medicaid/Medicaid HMOs & NPIs go on the claims?
Individual provider NPIs go in 24J on the claims, while group NPIs go in 33a on the claims.

How are RHC home visits billed?
Home visits are billed as RHC visits with revenue code 522 to the FI(MAC).

Where are injections billed?
Injections are bundled with an encounter for billing. They are NOT billed to Medicare part B.

What procedures go on a HCFA1500 to Medicare part B?
Procedures that should be listed on a HCFA1500 to Medicare part B include labs, tech ekg and tech x-rays.

Can we bill a nurse visit to Medicare in an RHC?
No, a practice may not bill a nurse visit to Medicare in a Rural Health Clinic (RHC.) Rural Health Clinics are designated by Medicare. In some states, the RHC will also be designated as a RHC by Medicaid. When so designated, the clinic is paid an all-inclusive rate for services performed on that day, at any level of service. However, in order to bill Medicare and be paid the all inclusive rate, the service must meet the definition of a visit. Here is how that is defined in the Medicare Claims Processing Manual: The term “visit” is defined as a face-to-face encounter between the patient and a physician, physician assistant, nurse practitioner, nurse midwife, visiting nurse, clinical psychologist, or clinical social worker during which an RHC/FQHC service is rendered. (See the Medicare Benefit Policy Manual, Chapter 13, for definitions of these personnel. See also the Medicare Benefit Policy Manual, Chapter 13, for conditions of coverage for visiting nurse services).The expense of the nurse is included in the all-inclusive rate, and in the cost report. It is not permitted to bill Medicare for a nurse visit in an RHC.