BLOG

RHC Billing 101 – Basics of Rural Health Center Services

WHAT ARE RURAL HEALTH CENTERS?

Rural Health Centers, RHCs, are clinics that are certified to receive special Medicare and Medicaid reimbursements. These clinics are intended to help improve the accessibility of healthcare in underserved rural areas. There are 2 types of RHCs:

Independent RHC

  • Generally private practice
  • Professional Billing is submitted under the clinic’s Part A number
  • Technical billing is submitted under the clinic’s Part B number

Provider Based RHC

  • Clinic is owned and directed by the hospital, nursing or home home health agency
  • Professional Billing is submitted under the clinic’s Part A number
  • Technical billing is submitted under the Hospital’s Part A number

 

RHC MEDICARE BILLING

Medicare Revenue Codes

RHCs bill Revenue Codes on the UB-04 claim form when billing to Medicare. Below are the most commonly billed Revenue Codes

  • 0521: Clinic Visit at RHC by qualified provider
  • 0522: Home visit by RHC provider
  • 0524: Visit by RHC provider to a Part A SNF bed
  • 0525: Visit by RHC provider to a SNF, NF or other residential facility (non-Part A)
  • 0527: Visiting Nurse service in home health shortage area
  • 0528: Visit by RHC provider to other non-RHC site
  • 0900: Service subject to Medicare outpatient mental health treatment limitation
  • 0780: Telehealth from originating site

All RHC Medicare claims are filed using the UB-04 forms and use type of bill code 711.

The practice management system should take all of the charges and have them rolled into one line item with the correct revenue code. Exceptions to the rollup would include G0402, G0438 and G0439.

As of Oct 1, 2016, clinics must append modifier CG to the visit code that represents the primary reason for the face to face visit.

See the CMS Medicare claims processing manual for additional information.

Qualifying Medical Visit billed to Medicare

RHCs report one service line per encounter/visit with their appropriate revenue code (052X) and a qualifying medical visit from the RHC Qualifying Visit List. The clinic needs to bill out the actual charges being rendered, not the encounter rate.

*Medical visit billed to Medicare*

Here is an example of what a qualifying medical visit claim should look like in the system:

*Preventive visit billed to Medicare*

Here is an example of what a preventive visit claim should look like in the system:

*Medical and preventive visit billed to Medicare*

Here is an example of what a medical and preventive visit claim should look like in the system:

 

RHC Medicaid Billing

RHC Medicaid billing can vary depending on the state billing rules. Clinics should go to their state GOV website to obtain a the RHC billing manual for the state. Some states will require Medicaid claims to be submitted on 1500 claim forms while others will require Medicaid to be billed on the UB-04 form.

 

RHC Non-Medicare and Non-Medicaid Billing

Commercial, workers compensation and auto claims will be filed as you would for any facility, on a 1500 claim form.

Self-pay services will be billed using the self-pay service guidelines the clinic has established. Typically done through patient statement services.

 

RHC billing is far more complex than physician practice billing. To be successful, it is important to have key billing personnel who understand this type of billing. Physician Services USA has RHC knowledge and experience and can help if you have any questions.

Call us today! We are happy to answer your questions and/or set up a free practice consultation.

Call 800-599-7183 or email: info@physicianservicesusa.com

 

 

secure client portal

Secure Client Portal

Use our client portal to
make a secure payment.

Revenue Analyzer

Revenue Analyzer

Try our revenue analyzer to calculate your practice performance for free today!