part ii policies and procedures for rural health clinic services

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APPENDIX HVACCINE FOR CHILDREN PROGRAMImmunization – Vaccines For Children (VFC)Providers who wish to obtain enrollment information or general information regarding the VFCProgram should refer to the Health Check Services Manual on-line at www.mmis.georgia.gov.or call 1 (800) 766-4456.January 2012 Rural Health Clinic Services H-1
Rev. 01/09APPENDIX ICHANGE IN SCOPE OF SERVICES(1) “Change in Scope of Service” is defined in accordance with Section 1000 of this manual andgenerally represents the following:(a) The addition or deletion of a new category of service as defined in Section 901 and904 of this Manual; or(b) The department has granted a request filed by an RHC that a service has changed inscope as described in Section 1001.2 of this Manual.(c) “Increase or decrease in the scope of services” means the addition or deletion of acategory of service or the department has granted a request filed by an RHC that aservice has changed in scope as described in Section 1001.2 of this Manual.(2) A change in scope of service may include but is not limited to the following:(a) The addition of a service that has been mandated by a governmental entity such as thecenters for Medicare and Medicaid services (CMS) in federal statute, rules, or policiesenacted or amended after January 1, 2002;(b) The addition of an obstetrical-gynecological physician or nurse mid-wife or otheradvanced practice nurse with a certification in obstetrical-gynecological services to anRHC site that did not previously offer obstetrical services;(c) The addition of a physician to a site that only offered nurse practitioner servicespreviously; or(d) An increase in the intensity of services provided.(3) The following situations are not considered a change in scope of services:(a) Wage increases;(b) Negotiated union contracts;(c) Renovations or other capital expenditures;(d) The addition of a disease management program;(e) An increase in the number of staff working in the clinic such as the addition of:(i) A lower level staff member such a family nurse practitioner when a siteemploys a family physician.(ii) A hygienist when a dentist is employed at the site;(iii) A physical therapy assistant when the site employs a physical therapist; and(iv) Social service staff;(f) An increase in office space that is not directly associated with an approved change inscope of service, e.g., the addition of an obstetrical-gynecological physician;(g) An increase in equipment or supplies that is not directly associated with an approvedchange in scope of service, e.g., the addition of an obstetrical-gynecological physician;(h) An increase in patient volume; and(i) An increase in office hours.(4) An RHC‟s request for a rate increase due to a change in scope of service will be granted atthe sole discretion of the department. The calculated PPS rate for the service that changed inscope must increase by at least twice the MEI for that year before the department will grant therequest for a change in scope of service.January 2012 Rural Health Clinic Services I-1
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Page 10 and 11: PART II - CHAPTER 800PRIOR APPROVAL
Page 12 and 13: Rev 01/09Payments specified as the
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Page 16 and 17: 903.3 Laboratory ServicesRev 01/09R
Page 18 and 19: COS 600 ID. The procedure codes for
Page 20 and 21: 904 Other Ambulatory Clinics Servic
Page 22 and 23: 4. ResidentialRev 01/09Clinics may
Page 24 and 25: 1001. Reimbursement MethodologyPART
Page 26 and 27: health clinics, and the UB-04 claim
Page 28 and 29: APPENDIX BSTATEMENT OF PARTICIPATIO
Page 30 and 31: Rev 01/09Rev 01/09Rev 01/09Example
Page 32 and 33: APPENDIX EBILLING INSTRUCTIONS AND
Page 34 and 35: PLACE OF SERVICE CODES11 - Office12
Page 36 and 37: Completion of the Health Insurance
Page 38 and 39: OrEnter the Prior Authorization Num
Page 40 and 41: enter the date.Unsigned invoice for
Page 42 and 43: Completion of the National Uniform
Page 44 and 45: FL 42FL 43FL 44FL 46FL 47Revenue Co
Page 46 and 47: FL 68thru 75Codes prefixed in „E
Page 48 and 49: Established Patient 99391 - 99395Ne
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