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Advanced RHC BIlling Presentation: NARHC Fall 2019 St. Louis

October 11, 2019 By Charles James Jr.

Dear all –

Here is the updated Advanced RHC Billing presentation that I gave at NARHC this week.  I updated claim examples and added some explanation on service detail billing.  I thought my comments on billing full charge amounts vs using the “$.01” method needed a bit more clarification.  Let me know if you have any questions –

Charles

Advanced RHC Billing v.2019 Updated

Filed Under: Uncategorized

New RHC Final Rule – Patient Policies, Program Evaluation and Emergency Preparation

September 26, 2019 By Charles James Jr.

CMS Final Rule for RHCs and FQHCs!  Policy and Procedure Review, Annual Evaluation, and Emergency Preparedness requirements have been changed.

Document Number:  2019-20736 “Medicare and Medicaid Programs: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care. ”

The new final rule does the following:

  • changes the Policy Review and Annual Evaluations to biennial requirements.
  • changes the requirement for facilities to review their emergency preparedness program to at least biennial.
  • eliminates the need to document outreach efforts to local emergency resources, but facilities will “still be required to include a process for cooperation and collaboration” with them.
  • requires facilities to provide training biennially or every 2 years, after facilities conduct initial training on their emergency program.
  • requires that providers of outpatient services conduct only one testing exercise per year, that either a community-based full-scale exercise (if available) or conduct an individual facility-based functional exercise every other year.
  • In the opposite years, these providers may conduct the testing exercise of their choice, which may include either a community-based full-scale exercise (if available), an individual, facility-based functional exercise, a drill, or a tabletop exercise or workshop that includes a group discussion led by a facilitator.
  • if a provider experiences an actual natural or man-made emergency that requires activation of their emergency plan, inpatient and outpatient providers will be exempt from their next required full-scale community-based exercise or individual, facility-based functional exercise following the onset of the actual event.

https://www.federalregister.gov/documents/2019/09/30/2019-20736/medicare-and-medicaid-programs-regulatory-provisions-to-promote-program-efficiency-transparency-and

The following are now biennial, not annual requirements:

Review of Patient Care Policies §491.9(b)(4)

RHC and FQHC Program Evaluation – §491.11(a)

Annual Review of Emergency Preparedness Program – §491.12

Annual Emergency Preparedness Training Program §491.12(d)(1)(ii)

The requirements for the following have been eased:

Documentation of Cooperation Efforts – §491.12(a)(4) has been eliminated

Annual Emergency Preparedness Testing – §491.12(d)(2) – only one required per year

 

Let us know if you have any questions!

Charles

Filed Under: Uncategorized

“Healthcare deserts” are being created in Rural America.

May 13, 2019 By Charles James Jr.

“As emergencies rise across rural America, a hospital fights for its life”

https://www.washingtonpost.com/news/national/wp/2019/05/11/feature/whos-going-to-take-care-of-these-people/?utm_term=.667991f96042

Filed Under: Uncategorized

Medicare RHC Negative Payment

May 2, 2019 By Charles James Jr.

Dear all –

This is an example of the Medicare RHC Negative payment when the whole charge and deductible amount exceeds the RHC encounter rate.  Medicare Negative Payments Example

The correct way to get these posted to your patient accounts?  However you can get it to balance!!

Have fun!

Charles

Filed Under: RHC Help, Uncategorized Tagged With: RHC Medicare, RHC Negative Payment, Rural Health Clinic

RHC Emergency Preparedness Rule

February 2, 2017 By Charles James Jr.

RHC providers have new requirements!  CMS issued new Emergency Preparedness Rules which apply to all 17 provider types. As a result, Rural Health Clinic (RHC) providers need some upgrade! Please see my accompanying presentation which summarizes the CMS Rule.  The rule text was my sole source of information and text.

RHC Emergency Preparedness Presentation

Rule Change Background

On September 8, 2016 the Federal Register posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The regulation goes into effect on November 16, 2016. Health care providers and suppliers affected by this rule must comply and implement all regulations one year after the effective date, on November 16, 2017.

Purpose: To establish national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters, and coordination with federal, state, tribal, regional and local emergency preparedness systems. The following information will apply upon publication of the final rule:

  • Requirements will apply to all 17 provider and supplier types.
  • Each provider and supplier will have its own set of Emergency Preparedness regulations incorporated into its set of conditions or requirements for certification.
  • Must be in compliance with Emergency Preparedness regulations to participate in the Medicare or Medicaid program. The below downloadable sections will provide additional information, such as the background and overview of the final rule and related resources.

Filed Under: RHC Help Tagged With: Emergency Preparedness, RHC, Rule

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