CMS Issues Update to RHC/FQHC Medicare Benefit Policy Manual

On November 22, 2013, CMS issued revisions and clarifications to the RHC/FQHC Medicare Benefit Policy Manual (Pub 100-02, Chapter 13) that are effective January 1, 2014. Included in the updated manual are the following highlights: 

• As part of the conditions of participation for a Medicare certified RHC, a RHC must be in both a rural area and an underserved location. CMS indicates in the revised manual that existing RHCs are not currently required to continue to meet the location requirements. However, if a RHC is relocating or expanding they should contact their CMS Regional Office to determine any location requirements that might impact their status as a RHC.
    
• Another clarification is that RHCs and FQHCs are now required to post their hours of operation at or near the entrance that is easily readable by all. The information must state the hours and days of the week that the RHC/FQHC is open for services. If the RHC/FQHC is open solely for administrative reasons, these hours and days of the week should also be identified, but separately.
    
• CMS also clarified that RHC services provided by contracted non-physician practitioners will not be paid. Non-physician practitioner performing services at a RHC must be employed by the RHC or by an entity that has 100% ownership of the RHC (ex.-hospital), as evidenced by a W-2 from either the RHC or the entity that has 100% ownership.
   
• As part of the revised manual, CMS noted in applying the productivity standard that physicians who provide services on an irregular or short-term basis would not be subject to the productivity standards. However, physicians that perform services on a regular, ongoing basis for the RHC/FQHC are subject to the productivity standard, regardless of whether they are employed or contracted. In addition, the FTE utilized for a practitioner in establishing the productivity standard is the time spent seeing patients or scheduled to see patients. The FTE would not include any administrative time by the practitioner.
   
• In the co-mingling section of the manual, CMS clarifies further that if a practitioner of a RHC/FQHC furnishes a RHC/FQHC qualifying service at the RHC/FQHC, then this service must always be billed as a RHC/FQHC visit. This service should not be billed to Medicare Part B and carved out of the cost report.
   
• CMS also added a section in the manual in regards to Transitional Care Management (TCM) services. Effective January 1, 2014, a qualifying TCM visit constitutes a separate billable RHC/FQHC visit if this service is the only qualifying service provided on that day. If the TCM visit occurs on the same day as another billable visit, only one visit may be billed.

These are just a few of the items CMS has clarified through the updated benefit policy manual for RHCs and FQHCs. We recommend reviewing these items to ensure adherence to these clarifications from CMS. If you have any questions, please contact Brian Bertsch or your Eide Bailly representative.