Independent RHC In-Patient services are billed to Medicare
Part B on a 1500 claim form
Provider Based RHC In-Patient services are billed under the
Main Provider on UB format.
Some MACs will cover the In-Patient claim AND an office
encounter on the same date. Know your MAC and what
their payment guidelines are for this component.
EXAMPLE: If your MAC will cover both you may have the
following example.
Office visit and inclusive services billed to Medicare Part A on UB
format
In-Patient services billed to Medicare Part B on 1500 format.
NURSING HOME SERVICES
Nursing home services (including SNF) are billed to
Medicare Part A on a UB form.
MEDICARE COPAYS/DEDUCTIBLES
The effect on payment is an increase in the charge, and
in the co-insurance.
RHC services deductible is based on billed charges.
Non-covered expenses do not count toward the
deductible.
The cost for incident-to-services are included in the cost
report, but they are not payable on the claims.
EXAMPLE: The patient has an office visit for $65.00
and an injection for $40.00. There will be one line item
of $105.00 on the UB form with revenue code of 521.
The patient (or secondary) will be responsible for
$21.00 which is the 20% co-insurance
