Rural Health Clinics

Preventive Services RHC Payment Policy


by Bill Finerfrock

Earlier this year, NARHC strenuously objected to a CMS determination that certain preventive services provided in an RHC were not billable if provided as "stand-alone" services.  After engaging our friends in Congress on this, CMS recognized the error in this determination and reversed their policy in mid-August. 


This led to a further review of other preventive services and the ability of RHCs to bill for these services as stand-alone visits. Recently, CMS released an updated chart outlining the coverage policy for preventive services provided in an RHC.  An abbreviated version of the chart CMS produced is below.  It is also available for download on the CMS websiteAdditional information on payment and claims processing for RHC preventive services (and all other services) is also available in the various Medicare manuals which are accessible on theRural Health Clinics Centerpage of the CMS website.    read more 

Letter from the NARHC President  


by John Gill, PA-C

Happy New Year and welcome to 2015!  This year will present both challenges and opportunities. The "New Congress" with changes in committee leadership presents an opportunity for RHCs. We are  exploring issues that will enhance the RHC community. Bill Finerfrock and the Board of Directors for NARHC are busy prioritizing our issues and picking our battles. We are all hopeful for positive outcomes.


The Association continues to represent your issues to CMS and other federal agencies. We are collaborating with other associations where we find commonality on issues and will continue to seek those opportunities. If you have specific issues that you encounter with any of these agencies please let us know as you may be the first or you are part of something affecting the entire community.    read more 

NARHC 2015 Spring Institute
A conference "For and About" RHCs
  • Telehealth
  • Legislative Update
  • RHC 101: The Least You Need to Know
  • Uncovering Opportunities for Improvement through Data Analysis
  • ICD-10-CM
  • Information Systems Security & HIPAA
  • Management Issues (for PBs and Independents)
  • Hot Topics & Emerging Issues
    • CHOWS & Considerations Before Moving Your RHC
    • Recruitment & Retention of Physicians, PAs, & NPs
    • Ask the Experts Your Questions
  • Developing an RHC Manual
  • Survey & Recertification
  • Best Practices
  • Physician Compensation:  Moving from RVU to Quality Based
  • Understanding & Solving People Problems
  • Stage 2 Meaningful Use
  • RHC Billing (for PBs and Independents)
  • RHC Cost Reporting
  • Being Emotional Solid in a High Pressure Environment
  • MAC Discussions: Novitas, Noridian, WPS
Hurry! Registration rates increase a month before the conference. Also the last day to reserve a hotel room in the Hyatt Regency Riverwalk is Mar. 3rd (or BEFORE if block fills)! Very popular hotel!!!

Earn CEU Credit (tentatively AAFP, AANP, AAPC)        read more

2015 NARHC Membership

It's time to RENEW or Purchase!

The NARHC membership year is Jan.-Dec. so NOW is a good time to buy or renew.   Receive discounted conference registrations (San Antonio in the Spring, St. Louis in the Fall) and so many other benefits. If your clinic is a 1st-time NARHC member, receive a discounted first year rate! Associations, Consultants and Governmental entities are also welcome to join. Don't know if your organization is a member? Call us at 866-306-1961 for a quick lookup.

NARHC also offers a group discount (add. RHCs after the first join for $130 ea.) & discounted Joint Memberships with 3 State Assns (CA, MO, TX)!   read more  

PQRS Penalities
RHCs are Exempt when Claims were submitted using UB-04! 


PQRS penalties apply to Eligible Professionals who submit Medicare claims for professional services paid under or based on the Medicare Physician Fee Schedule (PFS) using the 1500 claim form.  


Rural Health Clinic claims are submitted using the UB-04 claim form.  Claims submitted using the UB-04 Claim form are exempt from PQRS penalties.  I think it is easier to understand if you think about this in terms of the claim form rather than trying to think about it in terms of services or hours of operation.  


Did the Eligible Professional (physician, PA, NP, etc.) seek Medicare payment using a 1500 claim form in previous years - specifically 2013?  If the answer is yes, and the Eligible Professional did not do PQRS reporting for those claims, then claims submitted in 2015 by those EPs using the 1500 claim form will be subject to the "payment adjustment" (reduction of 1.5%).  In future years, the payment adjustment will be 2% on their 1500 claims if they continue to fail to participate in PQRS.   read more

Mental Health Care: Not There Yet

Loopholes are Discouraging Patients from Seeking Care

A flood of patients who have become newly insured under the Affordable Care Act might be calling for appointments to visit their family care providers; but, this does not include people with mental health issues or substance abuse problems.


Though Obamacare extends coverage to this group - collectively referred to as behavioral health - various loopholes in the health care law at this time have kept people from requesting mental health care. Some states haven't expanded Medicaid leaving about 5 million in a coverage gap, the majority of whom, experts believe, need mental health care. In other cases, patients aren't even aware of the benefits they can get with their new health insurance.   read more 

Revised 855R Application Form

The revised CMS 855R application became available for use on the website as of December 29, 2014. MACs may accept both the current and revised versions of the CMS 855R through May 31, 2015, after which the revised CMS 855R application will be required to be submitted!


After May 31, 2015, MACs will return any newly submitted CMS 855R applications on the previous version (07/11) to the provider/supplier with a letter explaining that the CMS 855R has been updated and the current version of the CMS 855R (11/12) must be submitted.  Physicians, non-physician practitioners, providers, and suppliers must use the revised CMS 855R application starting June 1, 2015.   read more

NARHC Board of Directors

Candidates wanted for 3 openings on the 2016 NARHC Board of Directors. Board members serve 3-year terms (Jan. 2016-Dec. 2018). Candidates must be NARHC members. The ideal candidate will have leadership ability, extensive RHC knowledge, and be willing to assist in growing the Association Membership by being an advocate. It is hoped that he/she will cultivate a relationship with their particular State Association. These positions will be voted upon by the membership electronically and at the Annual Meeting, held during the 2015 NARHC Fall Institute (in October) in St. Louis.  read more

Staff Retention: Rethinking the Approach


"Businesses are investing millions of dollars daily on recruitment, when in fact

they should be focusing on employee retention.  An army of recruiters are being

sent to the front line every day, while no one is manning the back door. If you

were fighting a war, you'd be dead." --Roberta Matuson, Forbes Magazine 3/13/2013


Prior to my current employ, I had been a hospital staff nurse and my average length of

employment was one to two years.  Among my peers/specialty, this was a pretty average number.  See the list of things loyal and content employees see as important.  read more  

RHC Cost Report Changes for 2015


Amazing how fast time flies by. Cost reporting season is upon us once again. As we prepare for the annual process of compiling information & submitting cost reports to Medicare & Medicaid, let's take a look at several changes that effect the 2014 cost reports.


A couple of housekeeping things to get started: the RHC payment limit per visit for 2015 is

$80.44, effective Jan. 1-Dec. 31, 2015. The 2015 RHC rate reflects a 0.8% increase above the 2014 payment limit of $79.80. This amount represents the maximum allowable cost per visit for independent rural health clinics and provider-based RHCs with more than 50 beds.   read more

Billing Services



There seems to always be questions on what or how the RHC should bill for allergy injections, therapeutic injections, injections after an initial visit, i.e. 2nd and 3rd injection of an antibiotic or any other nursing only service.  The RHC must remember that only a face-to-face service by a provider is billable to the Medicare payer


With this said, if there is a face-to-face visit on the same date-of-service of any of the services mentioned above all service charges would be bundled with the office visit charges and submitted on the one-line item with the 52X revenue code with the units of 1 and the total charges. When the RHC is instructed to "bundle" charges, this means that the charge for each of the services/items is added to the office visit charge to be submitted as the line item charge of the 52X revenue code for the RHC visit.    read more

New Year's Resolutions


The following list is most likely not everything you need to remember to do around

the first of the year, but I believe it's a really good start.  In addition to this list, you

really should consider losing that extra 20 (on in my case about 40) pounds, stopping those nasty habits, loving your spouse more, spending more time with your kids, and so much more.


Taking care of these important things will improve your productivity at work, and greatly enhance your relationships with those you work with.   read more

ICD-10 Deadline & Transitions   

"Road to 10" 


CMS has created "Road to 10,"an online resource, to help you jump start the transition to ICD-10. Built with the help of small practice physicians, "Road to 10" is a no-cost tool that will help you: 

  • Get an overview of ICD-10 by accessing the links on the the home pg.
  • Explore Specialty References by selecting a specialty below
  • Click the "Build Your Action Plan" box to create your personal action plan
Oct. 1, 2015, is the new compliance date for health care providers, health plans, &  health care clearinghouses to transition to ICD-10. HHS is also mandating continued use of ICD-9 through Sept. 30, 2015. By mandating use of ICD-9 through the end of Sept., 2015, individual payers cannot voluntarily seek to adopt ICD-10 prior to Oct. 1 as some had suggested. read more
In This Issue
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NARHC Spr Institute
Mar. 30-Apr. 1, 2015
Hyatt Regency Riverwalk
San Antonio, Texas
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