RHC Medicare Billing Resources

Healthcare Business Specialists, LLC is pleased to provide you with these billing resources to help your rural health clinic bill Medicare for your services. Billing RHC services requires the ability to create a UB-04 in an electronic format (837I). Many RHCs need access to Direct Data Entry (DDE) to verify coverage or adjust claims and Ability is a service that many of our RHC clients recommend.

4/13/2023 Mark Lynn presented at the Kentucky Primary Care Association on April 11, 2023 on RHC Billing Resources, Organizations that help RHCs, and common billing questions and answers. The presentation can be found here

2/14/2023 The Rural Health Association of Tennesse is providing a free webinar on Rural Health Clinic Billing on February 15, 2023 at 10:00 AM Central time until 11:00 AM Central time. To register see the link below and the presentation is available as well.

Medicare Online Manuals with RHC Billing Guidance:

Healthcare Business Specialists RHC Billing Policies

RHC Billing Guides and Tables from Medicare Administrative Contractors:

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RHC Billing 101 – Building Blocks – RHC Billing Pre-test, Resources, Charges, NPI numbers, Initial rate setting, Acronyms, Medicare Secondary Payor Questionnaire, 838 Credit Balance Report

February 17, 2022

In this webinar Mark Lynn from Healthcare Business Specialists will provide new RHCs the building blocks to begin billing as a rural health clinic. This webinar is designed for clinics new to the RHC program and have not billed as an RHC previously. The webinar will have an RHC Billing Pre-test, direct RHCs to billing resources, explain how to charge for services and to collect the correct co-pay and deductible amounts, issues with NPI numbers, commonly used acronyms, when to obtain a Medicare Secondary Payor questionnaire, and when to complete the 838 Credit Balance Report.

Sponsor Message: Azalea Health, Panelists: Dani Gilbert – Healthcare Business Specialists, Douglas Swords – Azalea Health,

Please register for RHC Billing 101 – Building Blocks – RHC Billing Pre-test, Resources, Charges, NPI numbers, Initial rate setting, Acronyms, Medic on Feb 17, 2022 1:00 PM EST at:

 https://attendee.gotowebinar.com/register/8120854765041309453

Here are the Resources for the webinar:

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RHC Billing 201 –  The Basics of Medicare billing for independent and provider-based RHCs with Amanda Dennison, MBA, CPC, CRHCP, Senior Consultant from Blue & Co. Sponsored by Blue & Co.

February 22, 2022

Amanda Dennison, MBA, CPC, CRHCP, Senior Consultant from Blue & Co. will go over billing basics for RHCs including claim forms, incident to, definition of a visit, bill types, revenue codes, Medicare Advantage billing, and ancillary services. Medicaid billing will not be covered in this or any of the sessions. This session is sponsored by Blue & Co.

Please register for RHC Billing 201 –  The Basics of Medicare billing for independent and provider-based RHCs with Amanda Dennison, MBA, CPC, CRHCP, on Feb 22, 2022 1:00 PM EST at:

 https://attendee.gotowebinar.com/register/4886054172729377292

Here are the Resources for this webinar:

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RHC Billing 301 – Completion of the UB-04 Form, Form Locator Values, Medicare Secondary Billing, and claim formatting by Douglas Swords from Azalea Health, sponsored by Azalea Health

February 25, 2022

In this webinar Douglas Swords of Azalea Health will cover the details of billing RHC claims including the claim formatting of the UB-04 form, the proper values to include in each form locator, the differences between Condition, Occurrence, and Value codes, how to bill Medicare as primary or secondary, what to do in the case of claim denials and the most common reasons for denied claims. Sponsored by Azalea Health.

 Please register for RHC Billing 301 – Completion of the UB-04 Form, Form Locator Values, Medicare Secondary Billing, and claim formatting by Douglas on Feb 25, 2022 1:00 PM EST at:

 https://attendee.gotowebinar.com/register/2726080072638165264

Here are the Resources for this webinar:

RHC Billing 401 – Advanced Subjects – Preventive Services, Mental Health Services, Billing Examples, Telehealth, Covid billing, and FAQs Sponsored by North American Healthcare Management Services

March 1, 2022

In this webinar Charles James from North American Healthcare Management Services will go over some advanced topics with billing examples, preventive services, mental health services, Telehealth, Covid billing, and FAQs answered by the panelists. Sponsored by North American Healthcare Management Services.

 Please register for RHC Billing 401 – Advanced Subjects – Preventive Services, Mental Health Services, Billing Examples, Telehealth, Covid billing,  on Mar 1, 2022 1:00 PM EST at:

 https://attendee.gotowebinar.com/register/5833772722735311886

Here are the resources for this webinar:

RHC Update for 2022 – RHC Billing, No Surprises Act, PRF Funds, sponsored by North American HMS

February 15, 2022

In this webinar, Charles James from North American Healthcare Management Services and Mark Lynn from Healthcare Business Specialists will update RHCs on changes to RHC reimbursement for 2022 including telehealth mental health visits now being paid at the all-inclusive rate, changes in the Telehealth payment rates, increased Medicare deductibles and the impact on negative reimbursement, No Surprises Act, changes to the billing of Covid vaccines and MABs for Medicare Advantage patients, PRF Reporting for Period 2, Cost Reporting, and other updates.

Elizabeth Morgan Burrows, JD, Principal, from Burrows Consulting, Inc. will be providing an update on grants management for all the RHCs that received the RHC Vaccine Confidence grants. Sponsor Message and Panelists: Charles James, North American Health Management Services, Mark Lynn – Healthcare Business Specialists, Dani Gilbert – Healthcare Business Specialists.

Please register for RHC Update for 2022 – RHC Billing,  No Surprise Act, PRF Funds, sponsored by North American HMS on Feb 15, 2022 12:00 PM CST at:

 https://attendee.gotowebinar.com/register/2423215196719722255

Here are the resources for the webinar:

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 Billing and Reimbursement for Mental Health Services in Rural Health Clinics

 In this webinar Charles James from North American Healthcare Management Services, Dave Jolly from Rural Behavioral Health, and Mark Lynn from Healthcare Business Specialists will go over how RHCs can incorporate mental health services in their rural health clinic and how to get paid for this service in the RHC setting. This webinar will focus on the reimbursement, billing, cost reporting, and administrative aspects of mental health programs in RHCs.

Here are the presentation from the webinar (due to a technical issue with GotoWebinar the session was not recorded as planned):

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Billing & Coding resources during Covid-19

3/26/2020 Special coding advice during COVID-19 public health emergency by: AMA Coding

3/23/2020 Coverage and Payment Related to COVID-19 Medicare by: CMS Fact Sheet

3/22/2020 2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs) by:CMS FAQ

3/18/2020 COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies by: Medicaid FAQ

Healthcare Business Specialists conducted a series of RHC billing webinars in January, 2020. The following links will take you to the recordings of the webinars.

We have provided the Slide Presentations for each of the webinars in the following links.

RHC Beginning Billing Series in December, 2018. Three Sessions were recorded in December. We will have one more in January 2019. Here are the links to the recordings of the webinars.

Here are the PDFs we used at each of the webinars if you want to follow along on payer or take notes.

After the Inspection - Medicare & Medicaid Enrollment

Whew, we passed the RHC inspection with flying colors (hopefully). Now what. Unfortunately, we are entering probably the most frustrating aspect of becoming of an RHC because you are expecting those buckets of RHC money flowing like manna from heaven. Unfortunately, the experience is more like the carrot being placed just out of reach of the mule. Each state is different, so we have prepared several reports for new RHCs depending on the state you are in. The links below will take you to the report for your state.

Alabama Medicaid Enrollment Resources for RHCs

Please find below several files provided by Alabama Medicaid on the enrollment process for RHCs. These forms will walk you through the Medicaid enrollment process and answers many of the questions RHCs typically have when enrolling in Alabama Medicaid.

Mississippi Medicaid Enrollment RESOURCES for RHCs

Please find below several files provided by Mississippi Medicaid on the enrollment process for RHCs. These forms will walk you through the Medicaid enrollment process and answers many of the questions RHCs typically have when enrolling in Mississippi Medicaid.

Tenncare Billing Resources

Tenncare was granted a moratorium for paying RHCs the enhanced RHC reimbursement rate effective October 25, 2017. We have included links to many of the documents regarding the moratorium. The moratorium was lifted on October 1, 2019. Please click the link below:

If you are a new RHC, you can now submit your quarterly Tenncare Wrap reports and recieve interim reimbursement at the average rates established by Tenncare for each of the Grand Divisions of Tennessee. The rates are as follows:

The interim rates are:

West     $141.49

Middle  $131.35

East        $137.99

West Virginia Medicaid Enrollment RESOURCES for RHCs

Please find below several files provided by West Virginia Medicaid on the enrollment process for RHCs. These forms will walk you through the Medicaid enrollment process and answers many of the questions RHCs typically have when enrolling in West Virginia Medicaid.

Healthcare Business Specialists Beginning Billing for Independent Rural Health Clinics Webinar Series in February, 2018

In February, 2018,  Healthcare Business Specialists, LLC conducted a series of webinars on RHC billing for Independent RHCs. We have provided the information from the webinars including PDFs of the slides and links to the recording of the presentations on Youtube:

The Youtube Recording of the sessions are below:

Chronic Care Management Med-Learn Matters MM1075 (7-page PDF)