Regulations and Compliance

Michigan Center for Rural Health > Programs > Primary Care >

Reimbursement Resources

RHC Modernization Act
Announcement of Payment Rate Increase for Rural Health Clinics (RHCs) for Calendar Year (CY) 2016
RHC Billing 101
Chronic Care Management for Rural Health Clinics- Beginning on January 1, 2016, RHCs and FQHCs may receive an additional payment for the costs of CCM services that are not already captured in the RHC AIR or the FQHC PPS for CCM services to Medicare beneficiaries having multiple (two or more) chronic conditions that are expected to last at least 12 months (or until the death of the patient), and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
- CMS CCM Document
- CCM Frequently Asked Questions
Medical Billing Information for Rural Providers and Suppliers (RHC starts on page 17).
CMS has issued guidance on the PCV13 (Prevnar) vaccine. This is now allowed as long as the beneficiary has received the original PPSV23 pneumo vaccine at least 11 months prior.
Effective January 1, 2016, Advanced Care Planning (ACP) (CPT code 99497) is a stand-alone billable visit in a RHC. See billing examplesSample Billing for ACP furnished by RHCs [PDF, 228KB]
RHC Preventive Services Chart [PDF, 364KB] - (Updated on 08/10/2016)

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.

http://www.michigan.gov/lara/0,4601,7-154-63294_72971_75394---,00.html

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

Accrediting Organizations
The Compliance Team

The Compliance Team offers an accreditation program specifically for RHCs. Their resources include operational assessments, quality assurance tools, and compliance programs to help clinics meet federal and state standards.

Quad A

Quad A accredits healthcare facilities, including Rural Health Clinics, to improve patient care through a rigorous process. They provide resources to help RHCs meet standards, focusing on patient safety, quality, and operational efficiency.

JCAHO

The Joint Commission accredits various healthcare organizations, including Rural Health Clinics, emphasizing patient safety, quality improvement, and regulatory compliance. Accreditation signifies a commitment to high-quality care and operational excellence, demonstrating adherence to standards beyond basic certification.

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