2017 NARHC-News                       Your RHC News Source                     Summer 2017 Edition
CMS Proposes to Expand
Low-Volume Threshold in MACRA

In June, CMS released their 1,050-page MACRA proposed rule for calendar year 2018.
The big proposed change is an increase in the low-volume threshold for participation in MIPS to $90,000 (up from $30,000) of Medicare allowable revenue or 200 (up from 100) Medicare part B patients. This proposed change should allow almost all RHC clinicians to be exempt from MIPS participation in performance year 2018.    Read More
Special Edits for G0179 and G0372

We have been informed by CMS Staff that HCPCS codes G0179 and G0372 will cause all RHC claims to reject until they can implement the proper edits in their system. The edits will not be made effective until April 1, 2018. Until that date, these services should not be reported on any RHC Medicare claim.     Read More
Early Bird Rates Right Now!
Crowne Plaza Indianapolis 
Downtown Union Station

Oct. 17-19, 2017 (Tues.-Thurs.)
A Conference "for & about" RHCs!

RHC Basics & Cost Reporting; Legislative Update; Emergency Preparedness & 9th Condition of Participation; Dealing with Tough Stuff; Unusual but Important Policies; Build a Quality Report Card; Regulations: Finding Answers; Cost Reporting Pitfalls & Big Rocks; Reporting Preventive Services & Problem-Oriented E&M Services in RHCs; PCMH Incentives; Survey & Certification; Best Practices; RHC Billing (for PBs & Independents); Policy & Procedure Manual (for PBs and for Inds); NARHC Annual Meeting; Team Building Change Mgm.

Room rates begin at $149/night! 
CMS Proposes Reimbursement Increase for Chronic Care Management

The Center for Medicare and Medicaid Services (CMS) released their 2018 Physician Fee Schedule proposed rule last week which proposes a significant increase to the RHC reimbursement for CCM services. 
Specifically, CMS is proposing the establishment of two new G codes for "care management" services. Currently, RHCs are only allowed to bill for a 99490 or "level 1" CCM service which pays $42.71.       Read More
Emergency Preparedness Surveyor &
Interpretive Guidelines for RHCs

If you remember Hurricane Katrina & the many problems it presented, then you know why CMS has new Emergency Preparedness regulations for all 17 types of providers including Rural Health Clinics. The regulations for RHCs are found at 42 CFR 491.12. Following are the CMS guidelines for surveyors which will help you make your preparations. The date for full compliance is November 15, 2017. Yes, only 5 months away.
491.12 (a) Emergency plan . The RHC must develop and maintain an emergency preparedness plan that must be reviewed & updated at least annually.     Read More
5 Ways for Healthcare Providers to Get Ready for New Medicare Cards

Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.
CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now. We'll start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.      Read More
Candidates Wanted for 3 openings

3-Year Term :  January 2018 - December 2020.  Candidates must be a current NARHC member. The ideal candidate will have leadership ability and extensive Rural Health Clinic knowledge. The candidate will assist in growing the NARHC Association Membership by being an advocate and it is hoped that he/she will cultivate a relationship with their particular State Association. We prefer candidates be located in a state not already represented on the Board.    Read More
Health Care Fraud Takedown

On July 13, the Department of Justice and the Department of Health and Human Services (DHHS) announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

"The United States is home to the world's best medical professionals, but their ability to provide affordable, high-quality care to their patients is jeopardized every time a criminal commits healthcare fraud." said DHHS Secretary Tom Price, M.D.   Read More
Continuing Population Loss: Rural Areas

USDA's Economic Research Service (ERS) tracks demographic change in non-metro areas and conducts research to help explain the relationship between population change and socio-economic well-being of rural residents. In its Population & Migration report released in June, the ERS finds that 14% of residents live in non-metro counties across the U.S., which cover 72 percent of the nation's land area. This is only a -0.4 percentage loss over last year, but population loss is not evenly distributed across all rural areas. 

For those regions experiencing the most out-migration, ERS identifies rising unemployment, housing market challenges and energy sector developments as factors in a continuing decline in rural populations.   Read More


Many of us are concerned about how & whether the new quality payment requirements affect RHCs. Medicare Access & CHIP Reauthorization Act was passed during the previous presidential administration. MACRA authorized new quality payment mechanisms to replace the Medicare Physician Fee Schedule. The Merit-based Incentive Payment System (MIPS) and Alternate Payment Mechanisms (APM) are the two main tracks that providers will be able to choose. All of you have spent significant time in webinars and teleconferences educating yourselves on these topics. 

To reiterate: Medicare RHC payments are not subject to MACRA incentives or penalties.  These incentives/penalties are applied to Medicare Physician Fee Schedule payments based on allowed charge amounts.  Our RHC claims are NOT paid on the Medicare Physician Fee Schedule.     Read More
HIPAA and The Emergency
Preparedness Plan 

As you work through your Emergency Preparedness Plan for your RHC or FQHC, keep in mind that you may already have some of the requirements in place through your HIPAA compliance program.  Some of the requirements of the Emergency Preparedness Plan overlap with HIPAA so you won't have to "reinvent the wheel" as they say.  Let's look at a few of those areas in your HIPAA security program where they both intersect.
Emergency Plan Risk Assessment:  You are required to conduct a risk assessment utilizing an all-hazards approach and it must be facility based or you can rely on a community-based risk assessment.  The risk assessment requires you to look at all probable emergencies. You will look at natural emergencies that can occur in your area and develop strategies for responding to those emergencies. Under the HIPAA security rule, you are also required to conduct a risk analysis to look at threats and vulnerabilities to your electronic systems that hold e-PHI, and threats to your facility that holds the electronic systems.    
Read More
RHC Cost Reporting (Not Again!)

Most of us have just finished cost report season and the last thing we want to think about is another cost report, but this is the best time to prepare for the next cost report that is due. If you have ever meet me, you probably figured out at 6'9, I played a lot of basketball growing up and through college. The coaches always told us the great players were made during the summer. That was when you put the work in to have a winning season. The same thing goes for RHC Cost Reports. Now, that the rush is over, summer is here and patient volume is somewhat lower in your clinic, it is a good time to look at how you operate and make improvements. As far as cost report go, some things that you can do to help prepare an accurate cost report are as follows:      Read More
Preparing for the Revenue Recognition Standard-Health Care Industry
In May 2014, the Financial Accounting Standards Board (FASB) completed its revenue recognition project by issuing Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers, which can be found in the new Accounting Standards Codification (ASC) Topic 606.
The new standard is effective for periods beginning after December 15, 2017, for public entities which include not-for-profit entities that have issued or are a conduit bond obligor for securities that are traded, listed, or quoted on an exchange or an over-the-counter market.  The standard is effective for all other entities effective for periods beginning after Dec. 15, 2018.       Read More
In This Issue
Quick Links
Upcoming Events
NARHC 2017 Fall Institute
Oct. 17-19, 2017 (T-Th)
Crowne Plaza Union Station
Indianapolis, IN
Click here for   more info .
NARHC, 2 E. Main St., Fremont, MI 49412  |   Ph. (866) 306-1961  |  FAX 866-311-9606
Email: newsletters@narhc.org  |  Website:  www.narhc.org