Arizona Rural Health Clinic Designation Manual - Arizona Center for ...

D. Frequently Asked Questions (con’t)
Q: Regarding supplies, in order to be covered in the RHC, what must the supply or service be
A: The supply or service must be of a type that would be furnished in a physician’s office; a type
that is commonly provided without charge or included in the RHC’s bill; and a type that is provided
as incidental to the service of the physician, nurse practitioner, physician assistant, clinical
social worker, certified midwife, or clinical psychologist.
Q: Are RHCs subject to “incident to” regulations as it relates to the provision of services by the
midlevel provider
A: No. The physician does not need to be present in the facility when a midlevel provider sees the
patient and midlevel providers can see patients new to the clinic.
Q: Do I have to log every flu and pneumoccal shot including non-Medicare patients
A: No. There is no requirement to log other payer types, however, the total flu and total pneumoccal
shots provided are needed to complete the cost report correctly.
Q: How are flu and pneumoccal shots billed in RHCs
A: A log or roster of Medicare patients is maintained and submitted with the cost report at yearend.
Medicare pays the cost of the shots. No bill is submitted to Medicare.
Q: What does Medicare require regarding documentation in the flu and pneumoccal logs
A: Patient Name, HIC Number (Medicare Number), and Date of service (shot).
Q: Can RHC bill for both a Rural Health Clinic visit and an inpatient admission on the same
day
A: No. Medicare would consider this double dipping.
Q: If you perform a surgery in the hospital using a global fee and the patient has a pre-op and a
post-op visit in the RHC, can I bill Medicare Part A for the RHC visits
A: No. Medicare would consider this double dipping.
Sources: Rural Resource Center, Rural Health Clinics, http://www.raconline.org/info_guides/clinics/rhc.php#faq;
J.E. Estes, Healthcare Horizon; Rural Resource Center, Federally Qualified Health Centers, http://www.raconline.
org/info_guides/clinics/fqhc.php.; National Association of Rural Health Clinics, RHC Technical Assistance, RHC
The Basics: Part II; Centers for Medicare and Medicaid Services, Announcement of Medicare Rural Health Clinics
(RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increase, http://www.cms.hhs.gov/Transmittals/Downloads/R796CP.PDF;
AHCCCS, Arizona state plan amendment (SPA) 03-007, http://www.ahcccs.state.
az.us/Publications/PlansWaivers/Amendments/MedicaidSPAs/2003/03_007ApprovalCMS1_5_04.pdf; Oregon Office
of Rural Health, Rural Health Clinics, http://www.ohsu.edu/ohsuedu/outreach/oregonruralhealth/clinics/aboutclinics.cfm.
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