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.
