part ii policies and procedures for rural health clinic services

Rev 01/09Payments specified as the PPS rates are all inclusive of professional,technical and facility charges including evaluation and management,routine surgical and therapeutic procedures and diagnostic testing(including laboratory, pathology and radiology) capable of beingperformed on site at the RHC and billed by the facilities‟ provider ID andTIN.a. Laboratory, pathology, radiology and medications administered arenot separately reimbursable. To the extent that the provider has thecapabilities to provide these services and historically provided theseservices, the RHC shall continue to provide such services.b. The bundling of therapeutic and diagnostic testing services in thePPS rate is not meant to imply that the RHC shall vend or refer outsuch ancillary services to other providers merely for the purpose ofmaximizing reimbursement.c. Health Check visits are reimbursable at the PPS rate only to thoseRHCs and their practitioners who are enrolled as Health CheckScreening providers. Abnormal Health Check Visits may be paid as asecond PPS rate on the same member for the same date of service.Services listed in Appendix J are separately reimbursed according toa fee schedule or Vaccine for Children applicable rules.901.2 Services and Supplies Incident to a Service VisitRev 01/09Services and supplies incident to a Service visit include those servicescommonly furnished in a physician‟s office and ordinarily renderedwithout charge or are included in the practice‟s bill, such aslaboratory/pathology services, radiology services, ordinary medications,supplies used in a patient service visit. Services provided incident to aservice visit must be furnished by an employee and must be furnishedunder the direct supervision of an RHC health care practitioner, meaningthe health care practitioner must be immediately available whennecessary even by telephone.The reasonable costs associated with these services were reported on theRHC cost report and were considered as part of the RHC PPS baselinerate calculation. (See Chapter 1000 for more information).Rev 01/09901.3 Location Where RHC Services Can Be ProvidedRHC “Core” Services can be provided at the Clinic, a hospital an (eitherin-patient or outpatient setting), at the patient‟s place of residenceJanuary 2012 Rural Health Clinic Services IX-2