Changes Coming in Rural Health Clinic Billing

Effective April 1, 2016, Rural Health Clinics (RHCs), including RHCs exempt from electronic reporting under Section 424.32(d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code and other required billing codes. RHC-qualifying medical visits are typically Evaluation and Management (E/M) type of services or preventive services. Refer to the RHC Qualifying Visit List provided in MLN Matters Number MM9269 for the HCPS code. The link to the related MLN Matters is provided at the end of this piece.

The most common Revenue Code associated with a RHC visit is 052X for E/M and preventive services. Payment for RHC services will continue to be made under the All-Inclusive Rate (AIR) system when all of the program requirements are met. There is no change to the AIR system and payment methodology, including the “carve out” methodology for coinsurance calculation, due to this reporting requirement. Make sure you’re billing staff and software vendors are aware of these RHC-related changes for 2016. If you have any questions on this topic, please contact us.