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Rural Health Clinics Center

Spotlights
  • 2015 Medicare Benefit Policy Manual, Chapter 13 - The Medicare Benefit Policy Manual, Chapter 13, has been updated, effective January 1, 2015.  Updates include new and clarifying information on the new FQHC Prospective Payment System (PPS) rate, adjustments, payment codes, and qualifying visits; RHC employment requirements; RHC and FQHC preventive health services; and other issues related to RHC and FQHC billing and services. See MM8981 [PDF, 153KB] for a summary of the updates.
  • 2015 RHC and FQHC Payment Rate Increases for RHCs and FQHCs Billing Under the All-Inclusive Rate System (AIR) and Urban and Rural Designations for FQHCs Billing Under the AIR.  See MM8980 [PDF, 86KB] .

  • Sample Billing for Screening Pelvic and Clinical Breast Examination (HCPCS Code G0101)

    Until further notice, claims for which G0101 is the only service furnished shall be paid based on a RHC’s AIR when submitted as shown in the following example on a 71X TOB with revenue code 052X:

    42 Rev Code 44 HCPCS/RATES 45 SERV DATE 46 SERV UNITS 47 Total Charges
    0521 Blank or Valid HCPCS code 10/01 1 $00.01
    0521 G0101 10/01 1 $XX.XX

    (Updated 9/10/14)

  • Vaccination is the Best Protection Against the Flu [PDF, 414KB]

  • Rural Health Open Door Forum – For information on current rural health issues and an opportunity to ask and get your questions answered, join the Rural Health Open Door Forum calls sponsored by CMS.  To sign up for notifications of the calls, see http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/index.html

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Important Links

Billing / Payment

Enrollment/Certification

Conditions for Coverage/Participation

Legislation

Regulations

  • CMS-1443-F (Text Version) - Opens in a new window - Prospective Payment System for Federally Qualified Health Centers; Changes to Contracting Policies for Rural Health Clinics; and Changes to Clinical Laboratory Improvement Amendments of 1988 Enforcement Actions for Proficiency Testing Referral; Final Rule with Comment; Published May 2, 2014.
  • CMS-1443-P (Text Version) - Opens in a new window – Prospective Payment System for Federally Qualified Health Centers, Changes to Contracting Policies for Rural Health Clinics; and Changes to Clinical Laboratory Improvement Amendments of 1988 Enforcement Actions for Proficiency Testing Referral; Proposed Rule; Published September 23, 2013.
  • CMS-3267-P (Text) - Opens in a new window - Part II--Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Proposed Rule; Published February 7, 2013.
  • CMS-1910-P2 (Text) - Opens in a new window - Changes in Conditions of Participation Requirements and Payment Provisions; Rural Health Clinics and Federally Qualified Health Centers; Published June 27, 2008.
  • CMS-1910-IFC (Text) - Opens in a new window - Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program; Suspension of Effectiveness; Published September 22, 2006.
  • CMS-1910-F (Text) - Opens in a new window - Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program; Published December 24, 2003.
  • HCFA-1910-P (Text) - Opens in a new window - Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program: Published February 28, 2000.

Educational Resources

External Links for Rural Health

Rural Research Centers