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Rural Health Clinics Center

Spotlights

  • Chronic Care Management (CCM) Services – RHCs can receive payment for CCM when CPT code 99490 is billed alone or with other payable services on a RHC claim. RHCs are not authorized to bill for any other CCM or behavioral health integration (BHI) services, and no other CCM or BHI codes should be used. For other information on CCM, please see the MLN Matters Article and CCM FAQs.
  • CCM Payment Correction - For claims with dates of service on or after January 1, RHCs have been receiving a locality adjusted payment rate for CCM services. Your Medicare Administrative Contractor (MAC) will adjust any claim processed incorrectly. No provider action is required.
  • 2017 Update - Medicare Benefit Policy Manual,
  • RHC Fact Sheet – (Updated on 1/1/2017)
  • Effective April 1, 2016, RHCs are required to report a HCPCS code for each service furnished along with an appropriate revenue code. For claims with dates of service on or after April 1, 2016, RHCs should follow the reporting requirements for modifier CG found in MLN Matters Article SE1611 [PDF, 59KB]  . For additional information, see RHC Reporting Requirements FAQs.
  • RHC Preventive Services Chart [PDF, 364KB]  - (Updated on 08/10/2016)
  • 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.  Sign up for call notifications.

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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.

External Links for Rural Health

Rural Research Centers

CMS Manuals & Transmittals

Coverage

Contacts

Educational Resources

Resources

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