NARHC-News: published quarterly                   Your RHC News Source                                            Winter 2016 Edition
Rural Health Clinics

Chronic Care Management for RHCs Begins


As many of you know, the Chronic Care Management (CCM) benefit was expanded to Rural Health Clinics on January 1, 2016 and aims to give providers a tool to better manage Medicare patients with two or more chronic conditions. The benefit requires, after an initial set-up, that auxiliary staff perform 20 minutes a month of "chronic care management services" such as a call or email to the patient to check on their status. The Rural Health Clinic may then bill Medicare for these services under CPT code 99490 and receive $42.91 a month.
The hope is that by paying for the delivery of chronic care management services, health professionals will be able to more efficiently care for patients with costly chronic conditions. In an ideal world, CCM will translate into greater patient satisfaction and improved outcomes, more revenue for RHCs and other primary care providers, and savings to the Medicare program: a seemingly win-win-win scenario. However, it is too early to tell if the promise of CCM will match the reality of CCM.  read more 

Medicare/Medicaid Enrollment Fee Finalized


In the December 3, 2015, Federal Register, the Centers for Medicare and Medicaid Services announced that the 2016 (calendar year) application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location will be $554.00. This fee is required with any enrollment application submitted on or after January 1, 2016 and on or before December 31, 2016.
Providers that are initially enrolling in the Medicare or Medicaid programs or CHIP, revalidating their enrollment, or adding a new Medicare practice location are required to submit a fee with their enrollment application.  
read more
2016 NARHC Spring Institute

The RHC Conference --  9 Breakouts, 20 Sessions
PRE-CON:  RHC 101 Basics; The Role of an RHC Mgr; Cost Reports 101
CONFERENCE:  Legislative Update; Practice Management Strategies for Success; Chronic Care Mgm (CCM) & Advanced Care Planning Benefit; RHC Billing: The Whole Enchilada; Human Resources & Employment Law;  Marketing & Branding Your RHC; Follow the Money: The Revenue Cycle; Tackling HIPAA Compliance: Risk Analysis & Management (workshop); RHC Cost Reporting; Survey & Recertification; Best Practices (panel); Quality Reporting + Incentives = Increased Revenue; MAC Discussions; Completing the PB-Attestation Statement; Texas Session: Medicaid Program Changes 2016 & Beyond.     read more
Funding Opportunity
$200,000 PER YEAR FOR 3 YEARS! 

The Federal Office of Rural Health Policy is pleased to announce the release of the FY 2016 Small Health Care Provider Quality Improvement Grant Program (announcement #: HRSA-16-019). Application materials are available: click here
The purpose of this funding opportunity is to provide support to rural primary care providers for implementation of quality improvement activities.  There are several changes to the program this year including alignment of the project with Delivery System Reform (DSR), demonstrating an improvement in health status, and showing a reduction in emergency department visits due to chronic disease.  Organizations will identify a patient population to track over the three-year project period, implement an evidence-based quality improvement model to provide a framework for improving care delivery, & use health information technology (HIT) to collect, report, and utilize information on cost & quality.  read more 

Letter from the NARHC President

Happy New Year to one and all!  It looks like 2016 will be at the very least interesting.  If you are not tired of political ads on virtually every form of media, then just wait. As we come closer to election time, everyone will be begging for Election Day!  However, this may be one of the most important elections in memory as it pertains to health care and in particular rural health care.
No matter who is elected at the Federal or State level change will occur. Whatever you think of the ACA and how it affects your practice and patients you will be seeing changes. Will the ACA be repealed, improved, or left alone? What about MEDICAID? Will the support continue, if not, what will the states be able to do to support the cost? Can your clinic survive without the adjustment? What about ACO's and the integration of health care, population health management, PCMH and many other "innovations" for delivering care?      read more 
Billing Questions & Answers

Question:   Any definitive date on when we "unbundle" claims?

Answer:      To clarify, I would not characterize any of the changes coming soon as "unbundling" of claims.  CMS has stated that beginning April 1, 2016, RHCs will be required to include the CPT/HCPCS codes of services rendered during the RHC encounter.  This is simply a requirement that RHCs provide additional information as to what actually happened during the encounter.  It does not represent an "unbundling" of the payment.  The original proposal was for this to begin January 1, 2016; however, in the Final Rule issued in November, CMS announced that the effective date was delayed until April 1, 2016.     read more 
How to Submit Documentation for ADRs

Novitas Solutions' Medical Review Department has noticed an increase in the improper submission of documentation in response to an Additional Documentation Request (ADR). Multiple occurrences have been identified of providers submitting redetermination forms in response to an ADR. Redetermination forms should never be used to submit documentation or records requested by an ADR but should only be utilized if you disagree with the initial claim determination.
The process whereby a contractor requests additional documentation after claim receipt is known as "development". When a coverage or coding determination cannot be made based upon the information on the claim and its attachments (e.g., due to a medical review of the service/claim), contractors may solicit for more information by issuing an ADR.          read more 
A Success Story

The RHC in Galt does many things to help patients every day, but occasionally certain patients tug on their heartstrings and the staff can tell they need some extra help to get them through.
There was one such patient, an elderly woman named Mamie.  Mamie has very poor eye sight.  She does have grown children, however, they never seem to be available to assist her or accompany her to her visits.  Mamie needed to complete paperwork at one of her visits and it became very apparent by her demeanor how frustrated she was and that she needed some assistance with this.    
  read more 
Preparing For Your Cost Report
It's that time of year again; time to gather information for the 12/31/2015 cost report.  Before you begin preparing the cost report, there are a few things you should have at your fingertips.  
  • Financial Statements matching the cost reporting period.  For most this will be 1/1/15 - 12/31/15.  For new clinics in 2013, financial statements must reflect costs from the date of the clinic's certification to 12/31/15. 
  • Hours of operation.  If the clinic has hours in which it operates as a non-RHC, the hours of operation must be split between RHC hours and non-RHC hours.  read more  
Is Your Back Office Working Against You?
There are many tasks required to run your health care facility beyond the provision of day-to-day services.  "Back office" tasks do not bring in income and can significantly increase or decrease the costs to run your physician practice, clinic, or nursing home.  The challenge is to find the most cost- and time-efficient means to accomplish these tasks so that the business runs smoothly and profits are maximized.

Back office tasks are behind-the-scenes tasks that are closely tied to the operations of any organization.  These tasks include bill processing, vendor payments, payroll processing, preparation of financial statements, human resource tasks such as hiring and performance appraisals, information technology tasks such as software selection, server maintenance, and much more.    read more
Making New Year's Resolutions for Your RHC

In the same way in which we all personally vow each January to have a healthier lifestyle, to be more organized, or to learn a new hobby, we can also resolve to improve a few things in our RHCs.  Below are my suggestions for an efficient and productive 2016.



This is a great time to take stock of the things that your clinic did right in 2015 and to celebrate those "wins" with your staff and providers. Starting off with an encouraging, positive attitude will set the stage for a great new year.



It's no secret in the RHC world that our patients and our communities are central to our mission. Take time to renew this vision with your staff and providers.  Keep the main thing the main thing in 2016.    read more 

HIPAA & Vendor Compliance
As if managing your own HIPAA compliance wasn't complicated enough, did you know your organization is responsible for ensuring vendor compliance?  You need to be collecting information from your business associates to show how privacy and security are being monitored. If you are ever audited or breached, an investigator will ask questions such as: 
  • Do you know the names and contact information for your business associates?
  • Do you know if your business associates subcontract? And if they do, what limitations are imposed to protect your PHI? Do they have BAAs in place with their subcontractors? And do they monitor the compliance efforts of those subcontractors?      read more  

Some of the major announcements from Medlearn Matters are accumulated in the following table.  Medlearn Matters also produces a weekly newsletter that is full of links to valuable information  for every Medicare provider called MLN Connects Provider News. The link below is to the most recent issue and includes a link to subscribe to this valuable newsletter.

One important notice that ALL RHCs should review and complete this process immediately is from a recent announcement from HHS on the extension of the Essential Community Provider (ECP) Petition deadline for entities to submit their petition to be on the 2017 list of Essential Community Providers until January 15, 2016.   read more 
In This Issue
Quick Links
Upcoming Events
NARHC Spring Institute
Mar. 14-16, 2016 (M-W)
Hyatt Regency Riverwalk
San Antonio, TX
Click here for  more info.
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