WHAT IS RHC?

A Rural Health Clinic is a clinic certified to receive special Medicare and Medicaid reimbursement. The purpose of the RHC program is improving access to primary care in underserved rural areas. RHCs are required to use a team approach of physicians and midlevel practitioners such as nurse practitioners, physician assistants, and certified nurse midwives to provide services. The clinic must be staffed at least 50% of the time with a midlevel practitioner.

 Provider based RHC is owned and directed by the hospital, nursing facility, or home health agency. 

 Professional billing is submitted under CLINIC Part A number 

 Technical billing is submitted under HOSPITAL Part A number 

 Independent RHC are generally private practices

 Professional billing is submitted under CLINIC Part A number. 

 Technical billing is submitted under CLINIC Part B number. This can be billed under the group, but each provider must be credentialed with Medicare Part B if they are seeing patients.

BENEFITS OF RHC STATUS

 RHCs receive special Medicare and Medicaid reimbursement. Medicare visits are reimbursed based on allowable costs and Medicaid visits are reimbursed under the cost-based method or an alternative Prospective Payment System (PPS). Ordinarily, this will result in an increase in reimbursement. RHCs may see improved patient flow through the utilizations of NPs, PAs and CNMs, as well as more efficient clinic operations.

REIMBURSEMENT FOR RHC

 RHCs receive an interim payment throughout the clinic’s fiscal year which is reconciled at the end of the fiscal year through cost reporting. The interim payment rate is determined by taking total allowable costs for RHC services divided by allowable RHC visits provided to RHC patients receiving core RHC services. 

 All state Medicaid programs are required to recognize RHC services. The states may reimburse RHCs under one of two different methodologies. 

 Medicaid agencies may also cover additional services that are not normally considered RHC services, such as dental services.