Regulations and Resources

Reimbursement Resources

RHC Compliance and Resources for Starting a New RHC

Rural health clinics may apply for certification to participate in the Medicare/Medicaid programs. The Centers for Medicare and Medicaid Services (CMS) contracts with LARA to evaluate compliance with the federal regulations by conducting certification surveys and complaint investigations.,4601,7-154-63294_72971_75394---,00.html

CMS has approved two organizations as Rural Health Clinic Accrediting Organizations. Information on both entities is below. 

What is an RHC?
Click here
 to see slides from "Alternate RHC Accreditation:  What is it?"
AAAASF Website

The Compliance Team
Compliance Team Standards
Presentation on RHC Accredidation
The Compliance Team Website

RHC Regulations and Application Resources

Medicare Benefit Policy Manual - Chapter 13 RHCs - Updated 1-15-2016 

Electronic Code of Federal Regulations

CMS 855R Information (Medicare Enrollment Application)

  • Medicare Enrollment Application
  • Physicians and non-physician practitioners must use the revised CMS-855R (Reassignment of Benefits) application beginning January 1, 2017. Medicare Administrative Contractors will accept both the current and revised versions of the CMS-855R through December 31, 2016. The revised form makes the primary practice location section optional. However, this information is shared with other programs, such as the Physician Compare Initiative, to help beneficiaries identify your practice.

Visit the Medicare Provider-Supplier Enrollment webpage for more information about Medicare enrollment.

  • Medicare Application Fee
    • Section 6401(a) of the Affordable Care Act (ACA) requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." The fee is to be used by the Secretary to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes, including those under section 1866(j) and section 1128J of the Social Security Act. Based upon provisions of the ACA this fee will vary from year-to-year based on adjustments made pursuant to the Consumer Price Index for Urban Areas (CPI-U). The application fee is to be imposed on institutional providers that are newly-enrolling, re-enrolling/re-validating, or adding a new practice location - for applications received on and after March 25, 2011.  The new application fee for CY 2016 is $554.
    • CMS has defined "institutional provider" to mean any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S or associated Internet-based PECOS enrollment application.
    • Link to pay Application 

Additional RHC Information and Resources: 

Regional Healthcare Coalition Contact Information
Top 10 Deficiencies during a site visit for RHC's in Michigan 
RHC Factsheet
RHC Manual - Starting a Rural Health Clinic - A How-To Manual (2004)
CMS Rural Billing Guide
Nondiscrimination Policies and Notices for Medicare Providers and Applicants
Credit Balance Report
EHR Contracts: Key Contract Terms for Users to Understand
The Compliance Team
HCPCS Code Updates - Released on December 28th, 2012
HRSA Rural Health ClinicTechnical Assistance Call Archive 
Hours of Operation Policy
Merit Based Incentive Payment & Rural Health Clinics 

Quality Assessment Performance Improvement Measures:

Complaint Log
Patient Complaints
Credentialing Tool
Diabetes Goal Contract
Diabetes Protocol Checklist
Disciplinary Guidelines
Disciplinary Action Form
Employee Credentialing
Privacy Complaint
Patient Satisfaction Survey
Quality Assessment Performance Improvement Plan

RHCs and FQHCs

RHC & FQHC Program Comparison    (At - a - glance version) 

PCMH Resources

National Academy for State Health Policy 
NASHP Website regarding Medicaid Activity in each state
NASHP Report 
NCQA Website