To Be or Not to Be.. a Rural Health Clinic
|
|
- Dustin Hart
- 5 years ago
- Views:
Transcription
1 To Be or Not to Be.. a Rural Health Clinic Virginia Rural Healthcare Association Annual Conference October 19, 2016
2 Today s Session 1. Rural Health Clinics (RHC) 2. Federally Qualified Health Centers (FQHC) 3. Requirements for RHC and FQHC 4. RHC Billing 5. RHC Regulatory Requirements 6. Panel Discussion 7. Group Q&A
3 A Rural Health Clinic is.. RHC = Rural Health Clinic It is a cost based reimbursed federal program for Medicare and Medicaid patients in a primary care office Provide healthcare services for insured, uninsured, and underinsured
4 Rural Health Clinic The Rural Health Clinic Services Act of 1977 (Public Law ) was enacted to address an inadequate supply of physicians serving Medicare patients in rural areas and to increase the use of non-physician practitioners such as nurse practitioners (NPs) and physician assistants (PAs) in rural areas. There are 4,099 RHCs nationwide furnishing primary care and preventive health services in rural and underserved areas. Source: CMS.gov
5
6 Why RHC? Higher reimbursement from Medicare and Medicaid Higher reimbursement for influenza and pneumococcal vaccines No reduced payment for NP & PA services Payment of Medicare bad debt %
7 RHC Requirements Be located in a non-urbanized area as defined by the United States (U.S.) Census Bureau and Be located in a Medically Underserved area (MUA), Health Professional Shortage Area (HPSA) or Governordesignated and Secretary-Certified shortage area: (designated within the last 4 years by HRSA) Provide outpatient primary care services Use the services of a PA, NP, or CNM at least 50% of clinic hours
8 RHCs May Be Either Independent (Free Standing) Owned and operated by a physician, NP, PA, or CNM Provider-based Owned and operated by a hospital, skilled nursing home or home health agency
9 Reimbursement Differences Independent Medicare payment $81.32 Use form 222 Ownership physician, NP, PA Provider-based No cap on Medicare payment when less than 50 available beds Must meet providerbased criteria 855A Ownership - hospital
10 What is a Provider-based RHC? It is not a provider-based clinic No EMTALA obligations No split billing requirements No 35 mile restrictions if less than 50 beds It is a subpart of the hospital The RHC has it s own NPI and PTAN number
11 Federally Qualified Health Center (FQHC) Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits.
12 FQHCs Provide care for people in rural and urban areas labeled as medically underserved areas or medically underserved populations(mua & MUP) Board of Directors required May receive funding for start up Must provide services to all community residents More comprehensive services: lab, diagnostic, behavioral and oral, after-hours, case management, pharmaceutical, transportation, interpretative services Under Federal objective review
13 FQHC Must: Serve an underserved area or population Offer a sliding fee scale Provide comprehensive services Have an ongoing quality assurance program
14 FQHC Certification Requirements To be certified as an FQHC, an entity must meet one of the following requirements: Is receiving a grant under Section 330 of the Public Health Service (PHS) Act or is receiving funding from such a grant and meets other requirements; Is not receiving a grant under Section 330 of the PHS Act but is determined by the Secretary of the Department of Health & Human Services (HHS) to meet the requirements for receiving such a grant (qualifies as a FQHC look-alike ) based on the recommendation of the Health Resources and Services Administration; Was treated by the Secretary of HHS for purposes of Medicare Part B as a comprehensive Federally-funded health center as of January 1, 1990; or Is operating as an outpatient health program or facility of a tribe or tribal organization under the Indian Self-Determination Act or as an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act as of October 1991
15 Differences Between RHC and FQHC Location urbanized vs. non urbanized Range of services Scope of benefits How federal government administers both programs
16 Overview of RHC and FQHC Programs Comparison of Basic Eligibility Criteria Criteria Rural Health Clinic Federally Qualified Health Center Location Non-urbanized Area N/A Shortage Area Corporate Structure MUA,HPSA or Governor Designated Shortage Area Unincorporated, public, nonprofit or for profit MUA or MUP Board of Directors N/A Required Tax-exempt nonprofit or public Clinical Staffing NP or PA required at least 50% of the time the clinic is open No specific requirements HRSA Comparison of RHC and FQHC
17 Management and Finance Evaluation Comparison of Management Criteria Criteria Rural Health Clinic Federally Qualified Health Center Compliance with Civil Rights Act Written Policies and Procedures Required annual evaluation of clinic operations Required Required Required annual evaluation of clinic utilization Assurance required Required Sliding Fee Scale Not Required Required Initial Application Application forms and on-site survey Application narrative and on-site survey (on-site survey is not mandatory for FQHCs or look-alikes at the time of application Recertification On-site survey State of compliance with program requirements Management and Control Systems Must demonstrate ability to manage costbased reimbursed Must provide written description of systems Independent Financial Audit Not Required Required Governance No specific requirements User-majority board of directors required HRSA Comparison of RHC and FQHC
18 Comparison of Required Scope of Services Criteria Rural Health Clinic Federally Qualified Health Center Primary Health Care Services Required Required Primary Care for all life-cycle ages Not Required Required on-site or under arrangement Basic Lab Six specified tests required on-site, others required on-site or under arrangement Required on-site or under arrangement Emergency Care First response capabilities required Required on-site or under arrangement Radiological Services Required onsite or under arrangement Required on-site or under arrangement Pharmacy Not Required Required on-site or under arrangement Preventative Health Not Required Required on-site or under arrangement Preventative Dental Not Required Required on-site or under arrangement Transportation Not Required Required on-site or under arrangement Case Management Not Required Required on-site or under arrangement Dental Screening for Children Not Required Required on-site or under arrangement After Hours Care Not Required Required Hospital/Specialty Care Required by clinic staff or under arrangement Required by clinic staff or under arrangement HRSA Comparison of RHC and FQHC
19 RHC - Conditions for Participation Compliance with Federal, State and Local Laws Location of Clinic Physical Plant and Environment Organizational Structure Provision of Services Patient Health Records Program Evaluation
20 RHC Organizational Structure The clinic is under the direction of a Medical Director Written material covering organization policies, including lines of authority and responsibilities Written policies should consist of both administrative and patient care policies Disclosure of names and addresses: The clinic discloses names and addresses of the owner, person responsible for directing the clinic s operation and physician responsible for medical direction.
21 Staffing RHC must employ at least one NP or PA (RHCs may contract with NPs, PAs, CNMs, CPs, and CSWs when at least one NP or PA is employed by the RHC) The staff is sufficient to provide the services essential to the operation of the clinic NP, PA, or CNM must be present 50% of clinic hours; and Medical Director must be on site for sufficient periods of time dependent on needs of facility and patients
22 Staff Responsibilities The Medical Director in conjunction with the NP or PA participates in the developing, executing and periodically reviewing the clinic s written policies and procedures as well as periodically, reviews the clinic s patient records.
23 Provision of Services Each RHC must be capable of providing out-patient primary care services RHC services include visit to the clinic, patients residence, assisted living facility, Medicare-covered Part A Skilled Nursing Facility Have arrangements with one or more hospitals to furnish medically necessary services that are not available at the RHC Have available drugs and biologicals necessary for the treatment of emergencies
24 Laboratory Services Provides basic laboratory services: Chemical examinations of urine Hemoglobin or Hematocrit Blood sugar Examination of stool specimens for occult blood Pregnancy test Primary culturing for transmittal
25 Non-Medical Emergencies The clinic assures the safety of patients in case of non-medical emergencies by: 1. Training staff in handling emergencies 2. Placing exit signs in appropriate locations 3. Taking other appropriate measures such as: bomb, fire and severe weather drills
26 Annual Program Evaluation The clinic carries out, or arranges for, an annual evaluation of its total program to include: The utilization of clinic services including number of patients served Random sample of both active and closed records (10 open and 5 closed) Review the clinic s health care policies for needed changes The clinic staff considers the findings and takes corrective action if necessary
27 Recertification Periodic on-site survey (at least once every 6 years) Unannounced Review of RHC Conditions of Participation Deficiencies: None, Standard, Condition Follow-up: Onsite or by mail Plan of Correction: Deficiencies corrected
28 Survey - Clinic Tour Drug samples Storage of medications include scheduled drugs no expired drugs Autoclave Exit signs Posted fire regulations Medical record review Conversation with staff Policy review
29 Survey - Clinic Tour - cont. Handicapped access Premises clean and orderly Infection control and equipment processing Preventive maintenance Fire safety and disaster drills
30 When to Notify State Agency Change of ownership Move to a new location Loss of NP or PA Staffing waiver request Change in Medical Director New NP or PA Termination of RHC New clinic to be certified
31 RHC Billing Cost based reimbursement Payments are based on an all-inclusive payment methodology and subject to maximum payment per visit an annual reconciliation referred to as an encounter rate Part B Deductible and coinsurance for Medicare patients is still 20 percent of the reasonable and customary charges except for certain services i.e., OP mental health treatment Medicare pays 100% percent of costs for preventative services
32 Annual Reconciliation Cost Report The RHC submits a report to the Medicare Administrative Contractor (MAC) that includes actual allowable costs and actual visits for RHC services for the reporting period and any other information that may be required The MAC divides allowable costs by the number of actual visits to determine a final rate for the period The MAC determines the total payment due and the amount necessary to reconcile payments made during the period with the total payment due Both the interim and final payment rate are reviewed for productivity, reasonableness, and payment limitations
33 Annual Reconciliation - Cost Reports Medicare Cost report due to Medicare MAC 5 months after fiscal year end. Ex: If your year end is 12/31, then it is due no later than 5/31
34 Cost Reports cont. Medicaid A projected cost report is submitted to the Medicaid Agency at time of enrollment as RHC to establish the all-inclusive encounter rate. However, if scope of services changes, additional information will need to be submitted for consideration of increase of rate.
35 How do RHC Costs Compare to RHC Payments? Finerfrock, W.: Capstone VRHA, 2016
36 RHC Cost Per Visit Comparison Finerfrock, W.: Capstone VRHA, 2016
37 RHC Cost Per Visit Comparison Finerfrock, W.: Capstone VRHA, 2016
38 How to Certify as an RHC? 1. Determine if site is eligible 2. Evaluate the financial feasibility of RHC status based on estimated data on payer mix 3. File an RHC application and a CMS provider enrollment form 4. RHC certification inspection 5. File a projected cost report to have Medicare rate determined
39 Virginia Rural Health Clinic Coalition Initiated in March 2016 Fourteen Rural Health Clinics Provides training, education, networking, regulation updates, RHC advocacy and more
40 Panel Discussion Travis Clark, President - Page Memorial Hospital and Shenandoah Memorial Hospital; VP of Operations Valley Health South Region Phillip Graybeal VP of Finance, Valley Health South Region Denise Dale Valley Physician Enterprise South Region Manager of Clinic Operations
41 References/Resources U.S. Department of Health and Human Services (2006): Comparison of the Rural Health Clinic and Federally Qualified Health Center Programs. Web site: U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (2016): Rural Health Clinic Fact Sheet. Web site: MLN/MLNProducts/downloads/RuralHlthClinfctsht.pdf National Association of Rural Health Clinic. (2016). Web site: National Rural Health Association, website 2016; State Operations Manual Appendix G Guidance to Surveyors -Rural Health Clinics, CMS. (2015). Web site: Guidance/Guidance/Manuals/downloads/som107ap_g_rhc.pdf Virginia Rural Health Association (2016). Web site: Medicare Benefit Policy Manual, Chapter 13 Rural Health Clinic and Federally Qualified Health Center Services (2016). Web site: GPO U.S. Government Publishing Office, ecfr (2016). Web site: BPART&ty=HTML
Maintaining RHC Compliance
2017 Rural Health Clinic Workshop Maintaining RHC Compliance October 18, 2017 1 RHC Overview Physical Plant and Environment Organizational Structure Staffing and Staff Responsibilities Provision of Services
More informationRURAL HEALTH CLINICS
RURAL HEALTH CLINICS Joan Hall, RN, President Nevada Rural Hospital Partners & Steve Boline, CPA, Regional CFO Nevada Rural Hospital Partners Legislative Committee on Health Care EXHIBIT G May 7, 2014
More informationReport of Survey RURAL HEALTH CLINICS
Name of Facility: Report of Survey RURAL HEALTH CLINICS Medicare Provider Number: Address: Facility Identification Number: City: County: Code: State: Zip Code: Surveyor s Name: Surveyor s Discipline: Dates
More informationThe federal guidelines governing the certification of. were published in the Federal Register on July 14, 1978.
RHC 101: Rules, Regulations and Rumors March 25, 2010 Rules The federal guidelines governing the certification of Rural Health Clinics (RHCs) were published in the Federal Register on July 14, 1978. Proposed
More informationProvider-Based RHC Billing June 8, 2018
Provider-Based RHC Billing June 8, 2018 Sharon Shover, CPC, CEMC 502.992.3511 Provider-Based RHC Billing Agenda RHC Encounters Payment for RHC Services Same Day Visits Revenue Codes CG Modifier & QVL Non-RHC
More informationRHC Basics and Beginning Billing 03/19/2018. Dedicated to improving access to quality healthcare in rural communities
RHC Basics and Beginning Billing 03/19/2018 Dedicated to improving access to quality healthcare in rural communities RHC Services An RHC Encounter is defined as a medicallynecessary, face-to face (one-on-one)
More information2016 Kentucky Rural Health Clinic Summit. Kate Hill, RN VP Clinical Services
2016 Kentucky Rural Health Clinic Summit Kate Hill, RN VP Clinical Services Operational excellence leads to clinical excellence Focusing on day-to-day operations can DECREASE COSTS while INCREASING QUALITY
More informationAgency for Health Care Administration
Page 1 of 50 FED - J0000 - INITIAL COMMENTS Title INITIAL COMMENTS CFR Type Memo Tag FED - J0003 - COMPLIANCE WITH FED,STATE,& LOCAL LAWS Title COMPLIANCE WITH FED,STATE,& LOCAL LAWS CFR 491.4 Type Condition
More informationRURAL HEALTH CLINIC BASICS GLEN BEUSSINK NATIONAL ASSOCIATION OF RURAL HEALTH CLINIC INDIANAPOLIS FALL INSTITUTE 2017
RURAL HEALTH CLINIC BASICS GLEN BEUSSINK NATIONAL ASSOCIATION OF RURAL HEALTH CLINIC INDIANAPOLIS FALL INSTITUTE 2017 AGENDA Overview RHC Rules Brainstorming Objectives & Questions and Answers Best Practices
More informationPrimary Care Options in Rural Healthcare. Jonathan Pantenburg, MHA, Senior Consultant September 15, 2017
Primary Care Options in Rural Healthcare Jonathan Pantenburg, MHA, Senior Consultant JPantenburg@Stroudwater.com September 15, 2017 Overview Overview Market Updates Definitions / Regulations Rural and
More informationRURAL HEALTH CLINIC PRE-CERTIFICATION PRACTICE TOOL Updated: March 2016
OREGON OFFICE OF RURAL HEALTH WIPFLI ASSOCIATES RURAL HEALTH CLINIC PRE-CERTIFICATION PRACTICE TOOL Updated: March 2016 JTAG REGULATION THINGS TO LOOK FOR MEETS SPECIFICATIONS (Y/N) ACTION NEEDED/COMMENTS
More informationRURAL HEALTH CLINICS PROVIDER MANUAL Chapter Forty of the Medicaid Services Manual
RURAL HEALTH CLINICS PROVIDER MANUAL Chapter Forty of the Medicaid Services Manual Issued December 1, 2010 Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable
More informationRural Health Clinic Overview
TrailBlazer Health Enterprises Rural Health Clinic Overview Steven W. Mildward Published March 2012 108724 2012 TrailBlazer Health Enterprises /TrailBlazer. All rights reserved. Important The information
More informationRHC COMPLIANCE AND REGULATIONS
RHC COMPLIANCE AND REGULATIONS ROBIN VELTKAMP HEALTH SERVICES ASSOCIATES OBJECTIVES Participants will gain an understanding of the basic Federal RHC Regulations. Participants will gain an understanding
More informationRural Health Clinics
Rural Health Clinics * An Issue Paper of the National Rural Health Association originally issued in February 1997 This paper summarizes the history of the development and current status of Rural Health
More informationBilling Guidelines for Federally Qualified Health Center, Rural Health Clinic or Encounter Rate Clinic
Provider Memorandum Billing Guidelines for Federally Qualified Health Center, Rural Health Clinic or Encounter Rate Clinic Molina Healthcare of Illinois (Molina) has implemented billing guidelines for
More informationPROGRAM INFORMATION NOTICE
PROGRAM INFORMATION NOTICE DOCUMENT NUMBER: 2003-21 DATE: August 26, 2003 DOCUMENT TITLE: Federally Qualified Health Center Look-Alike Guidelines and Application TO: Community Health Centers Migrant Health
More informationNational Association of Rural Health Clinics
National Association of Rural Health Clinics A Virtual Walk Through of a Rural Health Clinic October 17, 2017 Kate Hill, RN VP Clinical Services Inc. Tom Terranova Chief Operating Officer Who Is In The
More informationOverview of Health Center Program Requirements
National Association of County and City Health Officials Overview of Health Center Program Requirements March 18, 2010 Tonya Bowers, MHS Department of Health and Human Services Health Resources and Services
More informationRural Medicare Provider Types and Payment Provisions
Rural Medicare Provider Types and Payment Provisions American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues March 25-27, 2015 Emily Jane Cook I. What is Rural?- Common Rural
More informationThe Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
University of Southern Maine USM Digital Commons Faculty and Staff Books Faculty and Staff Publications 1-2003 The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook John
More informationProvider-Based: What Is It?
Compliance Risks for Provider-Based and Other Hospital-Based Provider Services 2015 HCCA Compliance Institute Presented by Regan E. Tankersley, Esq. Hall, Render, Killian, Heath & Lyman, P.C. Paul W. Kim,
More informationComplete RHC Medicare Billing
Complete RHC Medicare Billing 1 RHC Basics 2 What is a Rural Health Clinic? This CMS publication is an excellent resource as an overview of the RHC Program. Program Basics Certification Process Qualified
More informationWHY SHOULD A CHC/FQHC CARE?
Suzanne Niemi, CPA, CMPE, CCE Alaska Primary Care Association April 2017 Medicare Part A & Part B MACRA / MIPS Chronic Care Management Billing WHY SHOULD A CHC/FQHC CARE? 2 DEFINITIONS FQHC Federally Qualified
More informationCurrent and Emerging Rural Issues in Medicare
Current and Emerging Rural Issues in Medicare Captain Corinne Axelrod, MPH, L.Ac., Dipl.Ac. Senior Health Insurance Specialist Centers for Medicare and Medicaid Services Center for Medicare, Hospital and
More informationCERTIFIED RURAL CLINICS 2011
OREGON FEDERALLY CERTIFIED RURAL HEALTH CLINICS 2011 Report funded by a grant from O-HITEC O-HITEC 707 SW Washington St, Suite 1200 Portland, Oregon 97205 P: 503-943-2617 F: 503-943-2501 E-mail: info@o-hitec.org
More information(i) That individual is competent to provide nursing and nursing related services; and
483.75 Administration. A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial
More informationREVISION DATE: FEBRUARY
Mary Ann Hodorowicz, MBA, RDN CDE, CEC, Owner, Mary Ann Hodorowicz Consulting LLC, Palos Heights, IL Coverage: In-Person Payable Places of Services Excluded Places for Part B Payment Excluded Places: 0
More informationMedi-Pak Advantage: Reimbursement Methodology
Medi-Pak Advantage: Reimbursement Methodology The information located on the following pages is intended to summarize the reimbursement methodologies for Medi-Pak Advantage: Medi-Pak Advantage reimburses
More informationFEDERALLY QUALIFIED HEALTH CENTERS PROVIDER MANUAL
FEDERALLY QUALIFIED HEALTH CENTERS PROVIDER MANUAL Chapter Twenty two of the Medicaid Services Manual Issued December 1, 2010 Claims/authorizations for dates of service on or after October 1, 2015 must
More informationSURVEY OF VIRGINIA S RURAL HEALTH CLINICS
SURVEY OF VIRGINIA S RURAL HEALTH CLINICS Clinic Data and Needs Assessment Report Fall 2015 Survey conducted by Virginia Rural Health Association in partnership with mjs Consulting, Inc. Funding from Health
More informationProvider-Based Hospital Departments Are We Compliant?
Critical Access Hospital and Provider-Based Hospital Departments Are We Compliant? September 14, 2017 1 Reasons for Hospital/Clinic Integration History of Provider-Based Regulations Provider-Based Requirements
More informationCAH PREPARATION ON-SITE VISIT
CAH PREPARATION ON-SITE VISIT Illinois Department of Public Health, Center for Rural Health This day is yours and can be flexible to the timetable of hospital staff. An additional visit can also be arranged
More informationAppendix B: Formulae Used for Calculation of Hospital Performance Measures
Appendix B: Formulae Used for Calculation of Hospital Performance Measures ADJUSTMENTS Adjustment Factor Case Mix Adjustment Wage Index Adjustment Gross Patient Revenue / Gross Inpatient Acute Care Revenue
More informationHow to leverage state funding to bring federal dollars into Nevada
How to leverage state funding to bring federal dollars into Nevada EXHIBIT F Senate Committee on Health and Human Services Date: 2-12-2013 Page: 1 of 38 FQHC Opportunities for Federal Funding FQHC 101
More informationThis publication is made possible with partial funding from: U.S. Department of Health and Human Services Health Resources and Services
Arizona Rural Health Clinic Designation Manual August 2008 Version 3 This publication is made possible with partial funding from: U.S. Department of Health and Human Services Health Resources and Services
More information5/1/2017. Medicare Coverage Guidelines for DSMT and MNT Telehealth. Telehealth Defined
Medicare Coverage Guidelines for DSMT and MNT Telehealth Mary Ann Hodorowicz, RDN, MBA, CDE Certified Endocrinology Coder Mary Ann Hodorowicz Consulting, LLC 4-30-17 MEDICARE DSMT - MNT TELEHEALH KEY TOPICS
More information340B DRUG PRICING PROGRAM
340B DRUG PRICING PROGRAM Lindsey Imada, PharmD Candidate 2016 Midwestern University, Chicago College of Pharmacy Pro Pharma Pharmaceutical Consultants, Inc. Under the preceptorship of Dr. Craig Stern
More informationThe Regulatory Focus. Critical Access Hospitals The Regulatory Process
Critical Access Hospitals The Regulatory Process Montana DPHHS Quality Assurance Division Roy Kemp, Deputy Administrator rkemp@mt.gov The Regulatory Focus The fundamental principal of the state regulatory
More informationPayment Methodology. Acute Care Hospital - Inpatient Services
Grid Medi-Pak Advantage generally reimburses deemed providers the amount they would have received under Original Medicare for Medicare covered services, minus any amounts paid directly by Original Medicare
More informationAccreditation and Certification. Dorothy Dupree, Acting Director Margaret Brady, Quality Management Phoenix Area
Accreditation and Certification Dorothy Dupree, Acting Director Margaret Brady, Quality Management Phoenix Area 1 QUALITY PROCESS PYRAMID 2 Base Level 3 Medicare Conditions of Participation Compliance
More informationComparison of the Health Provisions in HR 1 American Recovery and Reinvestment Act
APPROPRIATIONS Comparative Effectiveness Research $1.1B for comparative effectiveness programs, including $300 M for AHRQ, $400 M for NIH, and $400 M for HHS. Establishes a Federal Coordinating Council.
More information340B Program Mgr Vice President, Finance SVP, Chief Audit, Ethics & Compliance Officer
340B Drug Purchasing Program Page 1 of 7 340B Drug Purchasing Program Policy & Procedure Number Policy Manual Ethics and Compliance Type Policy & Procedure Document Owner Effective Date Next Review Date
More informationHospice Program Integrity Recommendations
Hospice Program Integrity Recommendations Projected increases in the elderly population and the number of Medicare beneficiaries will likely result in continued growth in utilization of hospice services.
More informationCAHABA GOVERNMENT BENEFIT ADMINISTRATORS (GBA) PROVIDER-BASED ATTESTATION STATEMENT. Main Provider Medicare Provider Number:
Main Provider Information: Main Provider Medicare Provider Number: Main Provider Legal Business Name: Main Provider Doing Business As Name: Main Provider s Address: Attestation Contact Name (please print):
More informationFindings Brief. NC Rural Health Research Program
Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients BACKGROUND Andrea D. Radford, DrPH; Victoria A. Freeman, RN, DrPH;
More informationLoan Repayment for Primary Care Providers Practicing in Rural and Urban Health Professional Shortage Areas in Minnesota
2016 MINNESOTA STATE LOAN REPAYMENT PROGRAM INFORMATION NOTICE (PIN) Section 388I of the Public Health Services act, as amended by Public Law 101-597 and Public Law 111-148 Loan Repayment for Primary Care
More informationThe Healthier California Fund Grant Award Application
The Healthier California Fund Grant Award Application The Healthier California Fund: The Fund is a $20 million partnership between Capital Impact Partners and The California Endowment created to increase
More informationMedicare Cost Reporting and PPS FFY 2015 Proposed Rule Why it Still Matters. Glenn Grigsby, CPA OACHC 2014 Annual Spring Conference March 11, 2014
Medicare Cost Reporting and PPS FFY 2015 Proposed Rule Why it Still Matters Glenn Grigsby, CPA OACHC 2014 Annual Spring Conference March 11, 2014 Agenda Medicare cost report myths Common cost reporting
More informationSummary of U.S. Senate Finance Committee Health Reform Bill
Summary of U.S. Senate Finance Committee Health Reform Bill September 2009 The following is a summary of the major hospital and health system provisions included in the Finance Committee bill, the America
More informationSECTION 2: TEXAS MEDICAID REIMBURSEMENT
SECTION 2: TEXAS MEDICAID REIMBURSEMENT 2.1 Payment Information............................................................. 2-2 2.2 Reimbursement Methodology....................................................
More informationCredentialing Standards Presenters: Mei Ling Christopher Veronica Harris Royal
Credentialing Standards Presenters: Mei Ling Christopher Veronica Harris Royal Agenda Introductions Definitions vs. 2016 Regulatory Updates Survey Process Reminders Questions and Answers 222 Introduction
More informationCommunity Health Care And Emergency Preparedness. CNYRO HEPC Full Regional Meeting June 6, 2017
1 Community Health Care And Emergency Preparedness CNYRO HEPC Full Regional Meeting June 6, 2017 2 CHCANYS EM Team Alex Lipovtsev Assistant Director Michael Sardone Program Coordinator Gianna Van Winkle
More information(a) Licensure. A facility must be licensed under applicable State and local law.
42 C.F.R. 483.705. Administration. A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental,
More informationRecruitment & Financial Benefits of Health Professional Shortage Areas
Recruitment & Financial Benefits of Health Professional Shortage Areas Bobbi Buckner Bentz, MHA, MPH Primary Care Office Director Iowa Department of Public Health Presentation Goals What is a Health Professional
More informationPECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011
PECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011 PRESENTED BY ALVA S. BAKER, MD, CMD Maine Medical Directors Association Faculty Disclosures: Dr. Baker has disclosed that he has no relevant
More informationMissouri Rural Health Clinics and Electronic Health Records
March 2016 Missouri Rural Health Clinics and Electronic Health Records Survey Results Missouri Health Information Technology Assistance Center DEPARTMENT OF HEALTH MANAGEMENT AND INFORMATICS SCHOOL OF
More informationCritical Access Hospital Medicare Survey Preparation
Critical Access Hospital Medicare Survey Preparation The information in this document is provided to assist critical access hospital staff preparing for the next Medicare survey, and is divided into three
More informationIMCare Provider Manual Chapter 8 Clinic Services Revised 02/08/2018
Chapter 8 Clinic Services The following clinic services are included in this chapter: 1. Community Health Clinic (CHC) 2. Public Health Clinic a. Community Health Worker (CHW) Patient Education 3. Health
More informationRHC Billing for Provider-Based RHCs. Charles A. James, Jr. President and CEO North American Healthcare Management Services
RHC Billing for Provider-Based RHCs Charles A. James, Jr. President and CEO North American Healthcare Management Services Presentation Objectives Provider-Based Requirements Provider-based Enrollment Issues
More informationRetail Clinics in Healthcare: Overcoming Complex Legal Challenges
Presenting a live 90-minute webinar with interactive Q&A Retail Clinics in Healthcare: Overcoming Complex Legal Challenges Complying With Corporate Practice of Medicine, Licensure, and Scope of Practice
More informationI. Disclosure Requirements for Financial Relationships Between Hospitals and Physicians
2400:1018 BNA s HEALTH LAW & BUSINESS SERIES provided certain additional elements (based largely on the physician recruitment exception) are satisfied. 133 10. Professional courtesy, 42 C.F.R. 411.357(s)
More informationArizona Department of Health Services Licensing and CMS Deficient Practices
Arizona Department of Health Services Licensing and CMS Deficient Practices Connie Belden, RN., Bureau of Medical Facility Licensing August 8, 2013 General Comments Deficient Practices per visit Trend
More informationOverview of Select Health Provisions FY 2015 Administration Budget Proposal
Overview of Select Health Provisions FY 2015 Administration Budget Proposal On March 4, 2014, President Obama released his Administration s FY 2015 budget proposal to Congress. The budget contains a number
More informationBilling Maryland Medicaid: Guidance for SBHCs
Billing Maryland Medicaid: Guidance for SBHCs An update for billers Maureen Regan, Office of Health Services Presentation Overview Today s presentation will cover: Need-to-know terms and acronyms Medicaid
More informationThe SIA: Overcoming Organizational Fear of Closure
The SIA: Overcoming Organizational Fear of Closure Cathy Pusey, RN, Manager Clinical Analysts Patricia Neumann, RN, Sr. Patient Safety Analyst & Consultant Objectives Using the Systems Improvement Agreement
More informationHEALTH PROFESSIONAL WORKFORCE
HEALTH PROFESSIONAL WORKFORCE (SECTION-BY-SECTION ANALYSIS) (Information compiled from the Democratic Policy Committee (DPC) Report on The Patient Protection and Affordable Care Act and the Health Care
More informationRHC Billing - Introduction Fall, 2017
RHC Billing - Introduction www.ruralhealthclinic.com Fall, 2017 Contact Information Mark Lynn, CPA (Inactive) RHC Consultant Healthcare Business Specialists Suite 214, 502 Shadow Parkway Chattanooga, Tennessee
More informationThe SIA: Overcoming Organizational Fear of Closure
The SIA: Overcoming Organizational Fear of Closure Cathy Pusey, RN, Manager Clinical Analysts Patricia Neumann, RN, Sr. Patient Safety Analyst & Consultant Objectives Using the Systems Improvement Agreement
More informationTelemedicine and Reimbursement
Telemedicine and Reimbursement Presented for : March 14 th 2018 About Acevedo Consulting Incorporated Acevedo Consulting Incorporated prides itself on not providing cookie-cutter programs, but a quality
More informationPolicy Subject Index Number Section Subsection Category Contact Last Revised References Applicable To Detail MISSION STATEMENT: OVERVIEW:
Subject Objectives and Organization Pathology and Laboratory Medicine Index Number Lab-0175 Section Laboratory Subsection General Category Departmental Contact Ekern, Nancy L Last Revised 10/25/2016 References
More informationRE: CMS-1631-PM Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016
September 8, 2015 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-2333-P Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850 Main Office
More informationNOW, THEREFORE, be it resolved that DHS and HEALTH agree to perform the following in connection with this agreement: Purpose
COOPERATIVE AGREEMENT between NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES and NORTH DAKOTA DEPARTMENT OF HEALTH and PRIMARY CARE OFFICE/PRIMARY CARE ASSOCIATION This agreement has been made and entered into
More informationproviding quality, whole-person health care to all, especially the poor
A Federally Qualified Health Center providing quality, whole-person health care to all, especially the poor Three locations: East Liberty Lincoln-Lemington Hosanna House (dental care only) 6023 Harvard
More informationMay 3, 2018 Rick Reid Director, Provider Payment Analytics Michael Felczak Director, Provider Payment Analytics
Hot Reimbursement Topics Rural Area Hospitals May 3, 2018 Rick Reid Director, Provider Payment Analytics Michael Felczak Director, Provider Payment Analytics RICHARD S. REID, MPA, FHFMA, CPA, Director,
More informationCalifornia Community Clinics
California Community Clinics A Cohort Analysis Report, 2005 2008 Prepared by Capital Link in collaboration with the California HealthCare Foundation Connecting Health Centers to Capital Resources Copyright
More informationProvider Based Status Compliance: Space Sharing and Reimbursement Charges
Provider Based Status Compliance: Space Sharing and Reimbursement Charges Presentation by Karen Smith 614.227.2313 ksmith@bricker.com Claire Turcotte 513.870.6573 cturcotte@bricker.com Bricker & Eckler
More informationRural Health Clinic Billing
Critical Access Hospital and Rural Health Clinic Billing September 12, 2017 1 Rural Health Clinic Overview Rural Health Clinic Services Preventive Services in the RHC Non-RHC Services/Non-Covered Services
More informationAudit Your Practice Like a CPA
National Association of Rural Health Clinics Audit Your Practice Like a CPA Jeff Bramschreiber, CPA Health Care Partner March 21, 2018 Wipfli LLP 1 Audit Overview Do-It-Yourself Audit Approach Conclusion/Take-Aways
More informationEXTENDED STAY PRIMARY CARE
EXTENDED STAY PRIMARY CARE Working with Frontier Communities to Design Facilities that Work June 2000 Supported in part by the Federal Office of Rural Health Policy HRSA, DHHS Frontier Education Center
More informationSlide 1. Slide 2. Slide 3. Overview of RHC Regulations. RHC Billing Requirements. RHC Billing How To s. RHC Key Internet sites
Slide 1 By Janet Lytton, Director of Reimbursement Rural Health Development janet.lytton@rhdconsult.com September 2017 1 Slide 2 Overview of RHC Regulations RHC Billing Requirements RHC Billing How To
More informationPOLICIES & PROCEDURES
POLICIES & PROCEDURES ROBIN VELTKAMP HEALTH SERVICES ASSOCIATES OBJECTIVES Understand the key components and requirements Understand the annual review process, provider involvement and implementation Discuss
More informationNP or PA as Billing Provider
NP or PA as Billing Provider Claire Agnew, CPA MBA CHC Vice President of Financial Operations Phoenix Children s Medical Group Phoenix Children s Hospital Arizona s only children s hospital recognized
More informationSAFETY HONESTY CARING
Exemplary Provider Accreditation Program SAFETY HONESTY CARING QUALITY STANDARDS AND EVIDENCE OF COMPLIANCE Rural Health Clinics WWW.THECOMPLIANCETEAM.ORG COPYRIGHT 2012-2013 The Compliance Team, Inc.
More informationHighlights of Program Integrity Provisions Managed Care Delivery System Subcommittee June 9, 2011
Patient Protection and Affordable Care Act: Highlights of Program Integrity Provisions Managed Care Delivery System Subcommittee June 9, 2011 1 Provider Screening and Other Enrollment Requirements Provider
More informationAnnual Evaluation Not a medical Procedure
Not a medical Procedure What you should learn What is an Annual Evaluation, 491.11? When must it take place? Who completes it for the clinic? (policy) What occurs during the process? Facilitator? Not a
More informationMAXIMUS Webinar Series
MAXIMUS Webinar Series What the Provider Enrollment Rule Means Operationally for States and MCOs, Including Network Adequacy Continuing the Discussion on the CMS Rule for Medicaid & CHIP Managed Care June
More informationCore Services Provided in Federally Clinical Coverage Policy No: 1D-4 Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics
Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Federally Qualified Health Centers... 1
More informationFederal Regulatory Policy Report. NACHC Study: Benefits of the 340B Drug Pricing Program for Health Centers
Federal Regulatory Policy Report NACHC Study: Benefits of the 340B Drug Pricing Program for Health Centers May 2011 NACHC Study on the Benefits of the 340B Drug Pricing Program for Health Centers May 2011
More informationHome Health Agency Requirements CMS Emergency Preparedness Final Rule
Home Health Agency Requirements CMS Emergency Preparedness Final Rule The Centers for Medicare & Medicaid Services (CMS) issued the Emergency Preparedness Requirements for Medicare and Medicaid Participating
More informationSECTION 2: TEXAS MEDICAID FEE-FOR-SERVICE REIMBURSEMENT TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1
SECTION 2: TEXAS MEDICAID FEE-FOR-SERVICE REIMBURSEMENT TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2017 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2017 SECTION 2: TEXAS
More informationMedicare Conditions for Coverage 2009 Crosswalk
Medicare Conditions for Coverage 2009 Crosswalk By Dawn Q. McLane RN, MSA, CASC, CNOR Note: Changes between CfC prior to 2009 and CfC 2009 are denoted in red. Medicare CfC prior to 2009 42 CFR Public Health
More informationPromising Practices #9 May Community Health Center Incubator Programs: Providing State Support to Leverage Federal Dollars
Promising Practices #9 May 2010 Community Health Center Incubator Programs: Providing State Support to Leverage Federal Dollars The unprecedented federal investment in community health centers made in
More informationNebraska pays for telepsychiatry + a separate transmission fee ($.08/minute).
Nebraska pays for telepsychiatry + a separate transmission fee ($.08/minute). Nebraska Telehealth Statutes 2014 Legislative Bill 1076 enacted in 2014 allows Medicaid payment for telehealth when patient
More informationALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-14 FAMILY PLANNING TABLE OF CONTENTS
Medicaid Chapter 560-X-14 ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-14 FAMILY PLANNING TABLE OF CONTENTS 560-X-14-.01 560-X-14-.02 560-X-14-.03 560-X-14-.04 560-X-14-.05 560-X-14-.06 560-X-14-.07
More informationNARHC Spring Institute
NARHC Spring Institute Tuesday, March 15, 2016 San Antonio Conference Breakouts Your choice Regency Ballroom E Mac Discussion: Novitas Kim Robinson Live Oak Mac Discussion: Noridian Tana Williams You are
More information340B Drug Program Summary
Summary Congress created section 340B of the Public Health Service Act in 1992 to allow eligible health care providers known as Covered Entities to stretch scarce Federal resources, reaching more patients
More information10/21/2012. Healthcare in Very Rural and Frontier Communities: Balancing Equity, Effectiveness and Efficiency.
www.frontierus.org Healthcare in Very Rural and Frontier Communities: Balancing Equity, Effectiveness and Efficiency Susan Wilger, MPAff National Center for Frontier Communities American Public Health
More informationNEW LONG TERM CARE SURVEY PROCESS PHASE 2 REQUIREMENTS OF PARTICIPATION AUGUST 23, 2017
NEW LONG TERM CARE SURVEY PROCESS PHASE 2 REQUIREMENTS OF PARTICIPATION AUGUST 23, 2017 Disclaimer: The information contained in this presentation is representative of the current information provided
More informationSWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals
SWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals Federal Regulations Hospitals under 100 Beds Critical Access Hospitals CMS State Operations Manual Appendix T Regulations and
More information