NON RURAL HEALTH SERVICES

 These services are billed to Medicare Part B as FFS (fee for service) 

 Diagnostic testing (technical component) 

 X-ray 

 EKG 

 Laboratory services 

 Professional services done in the hospital

COMMINGLING

 Commingling is being paid twice from Medicare for the same service(s) and is considered fraud. 

 Since you are billing incident-to-services with the professional component to Medicare Part A as an RHC you cannot bill the same incident-to-services to Medicare Part B to receive a second payment.

MEDICAID BILLING

 Go into your state GOV website and find the RHC department. Search for the RHC billing manual for Medicaid in your state. 

 Some states require the Medicaid claims to be submitted on 1500 claim forms and others require Medicaid to be billed in the UB 04 format.

BILLING GUIDELINES

 All billing is subject to CMS guidelines. 

 Be certain that your credentialing/enrollment processes are correct and current. 

 Be sure that each provider’s NPI numbers are attached to the services rendered and that the NPPES website has current information. 

 Be sure that the clinic NPI number has the correct taxonomy codes including Rural Health Clinic. 

 Midlevel providers need to have their own Medicare Part B billing numbers 

 Know your carriers and if the midlevel needs to bill under the supervising physician or if they can be credentialed as a provider