Starting a RHC - A How-To Manual
This manual describes the steps that are required to become a certified rural health clinic and includes the necessary financial audit to determine the clinic's per visit rate. 

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What Is a Rural Health Clinic?
Rural Health Clinics (RHCs) were established by Public Law 95-210, the Rural Health Clinic Service Act, in 1977. Rural Health Clinics provide primary healthcare services in medically underserved areas and are certified under Medicare. The purpose of the RHC program is improving access to primary care in underserved rural areas. RHCs receive greater reimbursement for providing Medicare and Medicaid services in rural areas. The special rate is meant to result in greater reimbursement. The RHC will characteristically see an improvement in patient flow due to the utilization of mid-level providers such as NPs, PAs, and CNMs.

What Are the Advantages of Becoming an RHC?
   Greater reimbursement rate from Medicare and Medicaid
   Greater reimbursement for Flu and Pneumonia Shots (Medicare)
   No reduction for NP & PA services
   Payment of Medicare bad debt

What Are the RHC Requirements?  
There are certain criteria that must be met to become an RHC and it is crucial to know what this includes prior to applying for certification.

Location: The clinic must be located in a in a federally designated Medically Underserved Area (MUA), 4-year current Health Professional Shortage Area (HPSA), or a in an area designated as underserved by the State‚Äôs Governor.  The clinic must be located and in a non-urbanized area as determined by the U.S. Bureau of the Census. Each RHC must have its own four walls certified. An RHC can be a stand-along building or a part of another building. The only services considered RHC billable outside of the actual physical RHC structure are nursing home visits, home visits, and at the scene of an accident. A mobile unit may be certified as an RHC
Practitioners: The mid-level provider, NP, PA, CNM, must be providing patient care at least 50% of the operating clinic hours and there must be at least one employed mid-level and all others may be contracted, if desired. There must be a physician on staff who provides medical supervision, direction, and consultation. The physician may be contracted or a W-2 employee. All physicians and non-physician practitioners must be practicing in accordance with State law and State regulatory mechanism.

Services: The RHC must provide outpatient primary care service. There are six basic labs that are required to be provided within the clinic structure.

Other Requirements:
The clinic must be maintained consistent with State and local building, fire and safety codes. The building must be handicapped accessible.
   There must be a current and applicable policy & procedure manual.
   Drugs and samples must be stored safely, no expired drugs.
   Adequate medical records must be kept and maintained.
   The clinic must be under the direction of a Medical Director.
   To maintain RHC certification, there are periodic requirements including holding an annual committee meeting, annual Medicare/Medicaid cost report submissions, quarterly credit balance reports, final PPS rate setting with Medicaid, and annual policy & procedure manual review.

How Do I Know If Becoming an RHC Is Right for Me?
Becoming an RHC is not right for all clinics. First, you should complete a financial assessment. Second, you must be able to meet the above listed criteria. When a new client contacts HSA with RHC consideration in mind, we will complete the assessment before doing anything else. The Rural Assistance Center has a tool that is helpful

RHC Types:
Provider-based RHCs are owned and operated by an entity defined by Medicare statue as a provider. This includes a hospital, home health agency, or skilled nursing facility. Provider-based RHCs that are owned by a hospital with less than 50 beds are exempt from the per-visit cap reimbursement.

Independent or Free-Standing
Independent RHCs are stand along clinics, owned by a physician, NP, PA, or CNM, but may be owned by hospitals. They receive a capped reimbursement rate.

How Is an RHC Reimbursed?
Reimbursement: RHCs receive special reimbursement for Medicare and Medicaid services. Medicare visits are reimbursed based on allowable costs divided by allowable visits. All States must recognize the RHC program. Medicaid reimburses visits are reimbursed using one of two methods: 1) Under the cost-based method of an alternative Prospective Payment System (PPS) or 2) Alternative payment methodology which includes two requirements. First, the clinic must agree to the methodology and second, the payment must at least equal the PPS payment.

How Do I Apply to Receive RHC Certification?
There are several tasks to tackle in order to receive Medicare RHC Certification. HSA is very familiar with this process, each & every step of the way. Clinic location, staffing, and services must be verified; financial feasibility must be evaluated; forms must be completed and submitted to the appropriate processing agencies; a survey must be performed and passed; final approvals must be received; rates must be set; and unique RHC billing requirements must be utilized. Contact HSA for more information and for assistance with your certification.

What Are the Six Basic Lab Tests That Must Be Available in an RHC? 
   Chemical examinations of urine
   Hemoglobin or Hematocrit
   Blood sugar
   Examination of stool specimens for occult blood
   Pregnancy test
   Primary culturing for transmittal

Are There Disadvantages of an RHC?
Sometimes there is a delay of obtaining funding. Also, there can be a lack of understanding of the RHC program by Medicare Contractors or by the States. However, as your leader in RHC health care consulting, HSA has been successful in working with States across America to educate and inform clinics of the RHC purpose, structure, and how an RHC operates. 

I Have Changes to My RHC. Who Do I Notify? 
When there are changes to your RHC, notification is mandatory and part of the Medicare/Medicaid Reporting Requirements. The type of changes that are made, will depend on who requires notification (State, Medicare, Medicaid, CMS, etc.). Some of the most common changes include practice location address, board members, phone number, change of ownership, and termination. Contact HSA at info@hsagroup.net or 231-924-0244 for more assistance.