part ii policies and procedures for rural health clinic services

. 01/09Rev. 01/09Rev. 01/09Rev. 07/02such protocol to the Department, its authorized representatives orcontractual agents, upon request.Direct supervision does not mean that the physician must be in the sameroom when services are rendered. However, the physician must beimmediately available at least by telephone to provide direction orassistance when necessary.Services of licensed clinical psychologists and licensed clinical socialworkers are not required, but can be considered an RHC service whenthese personnel provide diagnosis and treatment of mental illness.Visiting nurse services must meet licensure requirements but can only beprovided as an RHC service in areas where there is a shortage of homehealth agencies. (See Chapter 903.8 of this manual for furtherdiscussion).The RHC agrees to provide the Provider Enrollment Unit a list of all thepractitioners providing medical services at the clinic with theirindividual assigned Medicaid provider number if they are enrolled in theMedicaid Program. Further, the RHC must submit all enrollment of anypractitioner in any Medicaid category of service other than the RHCProgram to the Provider Enrollment Unit.The RHC also agrees to notify the Provider Enrollment Unit of anychanges in the above and to keep these lists current in order to avoid lossof reimbursement for services provided by practitioners not identified asRHC‟s staff.601.4 Billing for RHC ServicesThe RHC agrees to bill the Department its usual and customary chargefor each RHC related service using applicable diagnoses and procedurecodes. RHC services must be billed using the RHC‟s NPI and Medicaidprovider number assigned to the specific RHC location and TaxIdentification Number (TIN) of the specific RHC location where theservices was provided and/or the rendering provider is based.“Usual and customary” is defined as the fee charged to private payingpatients for the same procedure during the same period of time. Recordson both Medicaid eligible and private paying patients must be maintainedfor a minimum of five (5) years in order to verify compliance with thispolicy. The RHC shall also furnish the Department, its authorizedrepresentatives or contractual agents, with all information that may berequested regarding “usual and customary” fees.January 2012 Rural Health Clinic Services VI-2