Rural Health Clinics

Letter from the NARHC Executive Director   

Congress Delays Medicare Reimbursement Cuts as Senate passes "doc fix"

by Bill Finerfrock

The United States Senate has joined the House of Representatives and passed legislation to prevent a 24% cut in physician fee schedule payments from occurring on 4/1/14 as previously scheduled.  Instead, Medicare physician fee schedule payments will continue to be paid as they have been for the past 3 months. 


In addition to preventing the SGR related reduction, Congress approved language extending various other Medicare provisions slated to expire at Midnight on 3/31/14.  These include:

  • Extends      Medicare work Geographic Pract. Cost Index floor for 1 yr
  • Extends      Medicare therapy cap exception process for 1 year
  • Extends      Medicare ambulance add-on payments for 1 year
  • Extends      Medicare adjustment for Low-Volume hospitals for 1 year
  • Extends      Medicare-dependent Hospital (MDH) program for 1 year

In addition to these "extenders" Congress also approved a one-year delay in the effective date of the ICD-10 transition.  As you know, ICD-10 was scheduled to take effect on October 1, 2014.  Due to Congressional intervention, the new effective date for ICD-10 will be October 1, 2015.

Mental Health & Substance Abuse Toolkit 


Mental health and substance abuse issues facing rural communities are often complex and require comprehensive approaches and proven strategies to coordinate and focus available resources for success, commented Walt Gregg, MA, MPH, Senior Research Fellow at the University of Minnesota Rural Health Research Center.


The Rural Assistance Center (RAC), the University of Minnesota Rural Health Research Center, & the NORC Walsh Center for Rural Health Analysis, recently launched the new Rural Mental Health and Substance Abuse Toolkit. The toolkit is designed to help rural communities & orgs develop & implement programs that meet the targeted mental health needs of communities based on proven approaches & strategies. The toolkit is available for free on the RAC website and contains...  

  • an overview on mental health issues in rural areas

  • program model examples

  • guidance on implementation, evaluation methods, & more. 


Click here to read entire article.

Funding Opportunities

Open funding opportunities through HRSA programs include:


HEALTHY START - HRSA is re-opening the competition period for Healthy Start, a program run by HRSA's Maternal and Child Health Bureau and up to 36 rural communities could be awarded up to $30 million to improve perinatal care outcomes. This is an important opportunity to increase access to perinatal care and reduce child and maternal health disparities in rural communities; please distribute widely to any rural stakeholders who may be interested in applying.  The guidance has changed significantly and the pool of funding is now available to a much broader range of potential applicants.  This is a unique opportunity for rural communities seeking to improve perinatal health.   


  • For community-based organizations, please consider applying.

  • For Associations, please share with your members.

  • For State Offices of Rural Health, please distribute widely.  

See the map below[1] to see if your state or region has high incidence of infant mortality (note that individual applicants will need to identify the rates of infant mortality and low birth weight for their own communities in 2007-2009 to determine eligibility).
read more 
NARHC 2014 Fall Institute
OCTOBER 22-24, 2014 -- Reno, Nevada

This conference is "For and About" RHCs. Look for registration/conference info on the NARHC website at the end of May.


Here are a few of the topics we're considering: Enrolling in an EHR incentive, RHC Management, Budgeting, Indep. Breakout, PB Breakout, How to add Ancillary Services in the RHC, Legislative Report, Billing, Cost Reports, Compliance & HIPAA, Managing Staff & Providers, Accreditation & Recerts, ICD-10 Training, Opening a New Clinic, Billing Carve Outs & Non-RHC Hours, Stage 2 Meaningful Use, MAC Discussions, and more!!! 


Early Bird rates in effect until Sept. 22nd!!!  We'd love to have you!  read more 

Superbill for ICD-10?  Unspecified Codes?


As of today, we know that the implementation of ICD-10 has been delayed until at least October 1, 2015.   However, we would be foolish not to use the extra time to make sure that we will be ready. t is not too soon to be continuing our preparation for the new code set.  One way to continue our preparation for ICD-10 is to analyze and revise our encounter form or superbill, whichever term you use to describe your charge entry sheet.


There is no one universal ICD-10 superbill for any specialty or at least not a really good one.  This is because there are 68,000 diagnosis codes in ICD-10-CM compared to 16,000 in ICD-9-CM. There is not a 1:1 ratio in mapping the codes. There are GEM mapping tools which get you in the right neighborhood for converting codes. Some of the mapping tools & quick guides that are being published are mapping nonspecific codes in ICD-9 to nonspecific codes in ICD-10.  read more 

Lab & Venipuncture


IT PROBABLY IS A DUCK  (or maybe not) 


On November 22, 2013, CMS released MedLearn Matters Number MM8504 which clarified or issued new guidance on 5 issues affecting RHCs. The billing process for venipuncture (HCPCS Code 36415) was one of the items that changed. In Chapter 16 of the Medicare Laboratory manual venipuncture is defined as "A specimen collection feeis allowed in circumstances such as drawing a blood sample through venipuncture (i.e., inserting into a vein a needle with syringe or vacutainer to draw the specimen)or collecting a urine sample by catheterization."


Since 2001, laboratory services have not been covered by Medicare under the RHC program allowing RHCs to bill and be paid by Medicare for laboratory services in addition to their RHC covered services. read more

Sample Meds


I'm finding that there is a significantly higher percentage of RHCs that I evaluate who no longer offer samples to their patients. This is due to several factors. The remote location of many RHCs creates a challenge for drug reps to travel to, so many of these don't have very many samples even given to them. With so few available it makes a lot of sense to simply not offer them at all, rather than keep up with the logging in and out.


This log, based on most state pharmacy board regulations, requires both the INCOMING and OUTGOING meds to be logged, including the patient name, drug name, dosage, lot number and prescribing provider. Just saying "sample given" in the EMR or chart is NOT a log, so this is an extra step for the provider, since again, in most states, ONLY the Medical Provider can dispense these samples (actually go to the sample closet, pull them, log them and hand them to the patient). read more 

Nominations Wanted:

NARHC's annual award recognizes and honors an outstanding leader/promoter of Rural Health Clinics. Nominations are sought for an individual who has dedicated their time & talent to advancing the health & well being of others through the RHC program. Persons doing the nominating should be NARHC members, however, award recipients do not have to be members. 


This sign of our appreciation and national distinction will be awarded at the NARHC Annual Meeting in the Fall (Reno, NV - Oct. 22-24, 2014).  The nomination deadline has been extended to May 31st, 2014. If you know of someone worthy of our recognition, please take a moment to fill out the Nomination Form.  Questions, email or call 866-306-1961.

How ACOs are Involving Rural Health Organizations

To date, little is known about Accountable Care Organizations (ACOs), nor how these newly-established organizations will fare as health care reform progresses. Even less is known about the structure and impact of ACOs serving rural areas, specifically as related to RHCs, rural FQHCs, and CAHs.


However, our recent study involving interviews with ACO leaders found that many ACOs are already beginning to partner with RHCs and CAHs. The ACO leaders also reported a strong willingness to improve care, health outcomes, & accessibility to services, as well as reduce gaps in care for rural patients. read more

Help Children & Teens Get Health Coverage  


Today, millions of children and teens across the country are uninsured but eligible for free or low-cost health insurance through Medicaid and the Children's Health Insurance Program (CHIP). And in states that are expanding Medicaid, many more parents - and other family members - may now qualify as well. You can help reach eligible families by joining with the Connecting Kids to Coverage National Campaign, a nationwide effort to spread the word about Medicaid and CHIP and get eligible children and teens enrolled.

read more
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NARHC Fall Institute
October 22-24, 2014
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