Interesting Billing Facts of Rural Health Centres (RHCs)

Did you know?

RHCs are facilities that offer services usually provided in an outpatient clinic setting. An RHC visit is defined as a medically necessary, one-on-one (face-to-face) medical or mental health visit with an RHC practitioner during which one or more RHC services are provided. 

There is a lot to know about the exciting billing facts of rural health centre, and let’s have a look at a few of them: 

Medical Necessity for RHCs Billing & Coding

One of the most prevalent justifications for payers to deny claims is a medical necessity. Clarifying the rationale for and outcomes of medical operations in the rural health centre billing record reduces back work and increases pay-outs to your practice. 

When preparing billing paperwork, keep the following typical difficulties in mind:

  • Should be defined from the perspective of a medical payer, which may differ from the clinical perspective.
  • Documentation confirming the ordered treatment is essential, as well as why it is necessary, is required.
  • Any ordered diagnostic test/procedure should include an “indication,” such as the reason for the test, and be linked to a diagnosis indicated in the chart.
  • As payer reviewers are frequently not professionally trained, terminology should be common, and treatments should be clearly connected to symptoms.
  • Some insurers/payers will not cover operations that can be done in an outpatient setting. 

Rural Health Centre Billing Checklist: 

While precise rural health centre billing and coding will help your practice, it does not ensure payment. Nonetheless, following best practices and meticulous documentation will help you get reimbursement. Medicare and Medicaid use the UB-04 form to assess reimbursements, but several difficulties can stand in your way. An essential checklist implemented before submitting your UB-04 can assist you in receiving your RHC reimbursements. It includes:

  • Each line must have a Revenue Code (often 052x/900).
  • Each service costing more than $0.01 must be listed on a separate line.
  • Each preventative service must be coded separately.
  • On the line of the UB-04 that totals all bundled charges, add the CG (Policy Criteria Applied) Modifier.

Printing out all revenue codes that apply to your practice is a simple way to ensure easy billing. As only some practices need to utilize every code, keeping an up-to-date list of your frequently used revenue codes will assist your rural health centre billing staff.

Qualifying Patients for Rural Health Centres

There are only a few requirements for an RHC-qualified outpatient visit:

  1. Face-to-face meetings with a clinician must be medically required.
  • No patient care is permitted until a healthcare provider arrives. A provider must be present on-site before a patient is roomed.
  • Cannot be in a hospital.
  • RHC visits are not permitted in hospice (except for non-hospice reasons).
  • Could be a swing bed in a hospital.
  1. Dentists, optometrists, podiatrists, and chiropractors are eligible for Medicare-covered services. These do not qualify as just on-site providers.
  2. Some preventative services (such as flu and HepB vaccines) may be eligible.
  3. It is possible to communicate virtually.
  4. It can be a visit between a home-bound patient and RN/LPN for skilled nursing care.
  5. Non-provider visits can be added 30 days before or after a provider contact.

RHC Ancillaries Billing

Coding for RHC ancillaries (lab testing/EKG/X-Ray) might be perplexing. A basic strategy to remember is to separate the technical (doing the test) and professional (interpreting the test) components for coding, as each goes on a separate bill. RHC cannot bill the technical component (testing); instead, it is billed by whoever does the test. RHCs can only bill for professional components (often 93005 and 93010, not 993000).

Outsourcing Rural Health Centres Billing & Coding

It can be challenging for rural health centre to determine whether outsourcing some of the medical billing procedures is the best option. Outsourcing medical billing services unquestionably aids in revenue cycle management. As a result of increasing rules and regulations, updated codes, and medical billing problems, profit margins in the private sector have shrunk; thus, outsourcing your RHC billing would be beneficial. 

Utilize the outsourcing services of 24/7 Medical Billing Services to quickly handle your rural healthcare centre’s complex medical billing and coding procedure. Take advantage of staying at the top and elevating your patient experience to new heights. Let us assist you in focusing on patient care and extending your exceptional service as you drive revenue and fully use your resources. At the same time, you reach a new level of profitability. 

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