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The document is a billing cheat sheet for Rural Health Clinics (RHC) detailing various billing procedures, codes, and payment methods for different types of visits and services. It outlines the billing forms (UB-04 and 1500), bill types, revenue codes, and whether CPT codes are required for independent and provider-based RHCs. Key areas covered include office visits, home visits, lab tests, injections, office procedures, EKGs, and homecare plan oversight.

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What is the modifier for RHC?

RHCs should report modifier CG on one line with a medical and/or mental health HCPCS code that represents the primary reason for the medically necessary face-to-face visit.

What is the 25 modifier used for?

RHC Split Claim Scenario Medicare has defined a list of non-RHC services that are covered however they are not reimbursed under the RHC reimbursement model. RHCs must bill these non-RHC services on separate claims from their RHC claims.

What is a method 2 billing RHC?

Method II is when the professional charges for service performed in a provider based department of a CAH are include on the outpatient hospital claim. This is only for NON-RHC clinics which are provider based and some provider based physicians.

What is the modifier 25 in RHC?

A: Medicare has very specific rules about the use of modifier 25. In the RHC, it would only be used in instances of subsequent illness or injury where the patient has a second E/M visit on the same DOS. The modifier 25 would be attached to the second E/M, along with a CG modifier.

How to bill an EKG in a Rural health clinic?

The technical component of an EKG performed is billed under the practitioners ID to Part B on the CMS-1500 claim form, with appropriate place of service. Provider based RHCs: The technical component of the EKG performed is billed by the base-provider on the UB-04 claim form.

rhc billing cheat sheet

Rural Health Clinic Billing Cheat Sheet 2023 RHC billing Cheat Sheet Rural Health Clinic billing Guidelines RHC billing guidelines 2024 Rural Health Clinic billing training CMS Rural Health Clinic billing guidelines RHC revenue codes RHC Billing 101

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Are RHC claims split billed to Medicare?

This helps ensure that healthcare services are reimbursed correctly, especially when different services seem similar but are distinct in nature and necessity. While Modifier 59 explains many separate services in one session, Modifier 25 shows vital, identifiable EM services on the same day as other procedures.

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Got questions?

What is the modifier for RHC?

What is the 25 modifier used for?

What is a method 2 billing RHC?

What is the modifier 25 in RHC?

How to bill an EKG in a Rural health clinic?

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Are RHC claims split billed to Medicare?

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