Regulations and Compliance

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 Clinic Technical Assistance Call Archive
• Hours of Operation Policy
• Merit Based Incentive Payment & Rural Health Clinics
• 2023 Michigan Communicable Disease Surveillance and Reporting Changes

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

Questions? Contact

Jill Oesterle
Director of Provider Solutions
517.353.6891
Oester35@msu.edu