RHC Client Information and Questionnaires

Client Information and Questionnaires

Thank you for engaging us to assist with the conversion of your physician practice to a rural health clinic. The process is long and will involve pulling together certain documents for various governmental entities which will review the submissions and approve them as we go along. The usual process takes between 6 months to a year to complete all five steps listed below.

1.     Preparation and submission of the 855As

2.     Preparation for State Inspection including preparing RHC and Emergency Preparedness Policy and Procedure manual.

3.     The State or Deeming Authority Inspection.

4.     Provider Number (CCN) and Rate Setting.    

5.     Medicaid Application and Medicaid Rate Setting

We have provided links to some of the forms and questionnaires we will be using during the RHC Startup process:

• Letter with resources and links to information for rural health clinics (Word)

• Letter with resources and links to information for rural health clinics (PDF)

• 855A Questionnaire for new RHCs (used to prepare the 855A) (Word)

  855A Questionnaire for new RHCs (used to prepare the 855A) (PDF)

• Policy and Procedure Manual Questionnaire (PDF)

• Healthcare Business Specialists Client Intake Form (PDF)

• Preparing for the RHC Survey, Slide Presentation, and Todo list by position (PDF)