Website     About     Services     Resources     Store     Contact

HBS Update  
February 24, 2016

CMS Open Door Session 
Moved to March 3, 2016
One of my favorite movies is A Good year which has beautiful scenery of Provence. One scene I remember is an elderly uncle telling his young nephew a joke, albeit not the best joke. "What is the secret to comedy?" and then completely too loud and not well timed he yells "TIMING". That was the way things went for me yesterday. I stayed up late Monday night to get a newsletter out first thing on Tuesday morning because of the importance of the CMS Open Door Session and the information and hopefully clarity that it would bring rural health clinics on the HCPCs billing issues effective April 1st, 2016. Not the greatest newsletter I had ever done, but certainly got the information on the Open Door Session and some webinars that were going on this week. 

A few minutes after the Newsletter was emailed, I got an email from CMS that the Open Door Session had been moved back one week to March 3, 2016 at 3:30 PM Eastern. So much for my TIMING. That announcements affects a couple of things. First, obviously the session will be one week later and RHCs will have one week less to prepare computer systems for implementation on April 1st. As one of our clients said "it's going to take at least a week to convince my computer programmers that I am not crazy" so we will have one less week to do so. Also, that will move back our webinar on HCPCS by one week as well as we are going to summarize the questions and answers provided by CMS in this webinar. So here are the updated announcements and sign ups for the webinar. 

The next CMS Rural Health Open Door Forum has been moved to March 3, 2016
CMS announced this morning that the Open Door Session scheduled for Thursday, February 25th has been moved back one week to March 3, 2016. Here is the formal announcement.
The next CMS Rural Health Open Door Forum is scheduled for:
Date: Thursday, March 3, 2016;
Start Time: 3:30pm-4:30pm Eastern Time (ET);
Please dial in at least 15 minutes prior to call start time.
Conference Leaders: Carol Blackford, John Hammarlund and Jill Darling.
**This Agenda is Subject to Change**
Opening Remarks
Chair- Carol Blackford, (CM)
Co-Chair - John Hammarlund, Regional Administrator, Seattle Regional Office
Moderator - Jill Darling, Office of Communications
Announcements & Updates
· RHC HCPCS Coding Update-Corinne Axelrod
· Critical Access Hospital Necessary Provider Designation Documentation- Kianna Banks
Open Q&A
Next ODF: April 14, 2016
Open Door Forum Participation Instructions:
This call will be Conference Call Only.
1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 38296329
Persons participating by phone are not required to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Encore: 1-855-859-2056; Conference ID: 38296329
Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID. Encores for ODFs held on Thursdays can be accessed the following Monday. The recording is available for 3 business days.
CMS Mission: As an effective steward of public funds, CMS is committed to strengthening and modernizing the nation's health care system to provide access to high quality care and improved health at lower cost.
HCPCS Webinar moved to March 4, 2016
Please register for Repeat Session: HCPCS Coding Changes effective April 1, 2016. A Brief Overview. on Mar 4, 2016 12:00 PM EST at: 

Due to the large number of people wanting to hear this webinar, we are going to repeat the session after the Rural Health Open Door Session next week. This webinar will focus on the recent revised guidance that CMS provided RHCs for billing effective April 1st, 2016. There are some issues that will take some time to code correctly and may cause billing issues in the future. Also procedures are going to be handled differently as well as the use of modifier 59.

Carolyn Duncan, BS, CPC, CPC-H of Health Care Consulting Services, Inc. has been added as a panelist and will help me conduct the webinar. Carolyn is an expert in CPT coding and has worked with Rural Health Clinics for a number of years.

After registering, you will receive a confirmation email containing information about joining the webinar.

Brought to you by GoToWebinar®
Webinars Made Easy®
Here is a link to the YouTube recording of our webinar on HCPCS Coding

RHC Cost Reporting and Webinar 
Today at 2:00 PM Eastern
We have been hard at work mailing cost report agreements, HIPAA Business Associate agreements, Medicare Checklists, and P S and R instructions to our clients. It is a long process as thankfully there are a lot of you. Look for the following documents in the mail very soon. If you do not get one and you want us to prepare your cost report, please let us know and we will get them out to you. Everyone should have this by the end of next week if all goes as planned. These are the documents that will be extremely helpful as you pull the information together to send to us to prepare the cost reports. Here are the links to the documents you will need .

Liquidate Accruals for Owners within 75 Days
Remember if you are an owner of a RHC and the RHC is a corporation, you only have 75 days after your fiscal year end to liquidate any accrual of bonus payable to you if you want to include it on the previous year's cost report as an allowable expense. Get those bonus checks written and cashed at the very latest on March 15, 2016 if you are December 31, 2015 fiscal year end.
Other types of vendors and employees can receive bonuses or accrued expenses within one year.

Help in getting your P S and R

To assist your cost report preparation, the Provider Statistical and Reimbursement (PS&R) summary report can be obtained from the CMS website: 

It is your responsibility to obtain the reports directly from the PS&R system. In an effort to ensure all providers have signed up for the PS&R system successfully, we are requiring an EIDM helpdesk ticket in order to process PS&R requests for FYEs 2009 and after.
If you have not signed up for an EIDM account, please visit the following link for information on obtaining access:

You must complete the registration process in order to pull your own PS&R going forward. Also, please ensure you log into the PS&R system every 60 days so you can change your password and keep the account active.
RHC Cost Reporting Webinar on Wednesday
Please register for RHC Cost Reporting for 2016 for Office Managers, Administrators, and RHC Providers.  Feb 24, 2016 2:00 PM EST at: 

This webinar will provide information on Medicare Cost Reporting for 2016 as it relates to the compiling of information related to your 12/31/2015 cost report. The information will emphasize what is important to obtain a timely filing of the cost report and an accurate cost report with maximized reimbursement from Medicare and Medicaid.

RHC Information Exchange Group is Growing
Thanks to everyone for joining the RHC Information Exchange Group this past week.  We have 30 new members and encourage everyone to join and exchange information about RHCs. Here is the link.
"A place to share and find information on RHCs."

CCM Billing Webinar with Care 24/7

Chronic Care Management Billing for RHCs on Apr 13, 2016 2:00 AM EDT at: 
FAQ on Chronic Care Management Released in February, 2016

Chronic Care Management is Not an 
Allowable Cost on RHC Cost Reports

There has been some confusion on how costs incurred as a result of providing CCM services should be reported on the cost report. Initially, CMS said that these costs were "allowable costs and included on the Medicare cost report."
However, CMS recently updated their FAQ on CCM services in RHCs to state that these costs are in fact "reportable costs" and CMS will provide a specific line in Worksheet A to report CCM costs. See question 14:
While this language is still vague, it is clear from our conversations with CMS  
that CCM costs will not significantly affect the All-Inclusive-Rate. Rather, these costs will be reported in a similar fashion to the way costs associated with Pharmacy/Dental/Optometry are reported.
Do not begin CCM services under the assumption that costs incurred providing CCM will result in a better AIR.
Nathan Baugh
Director of Government Affairs
National Association of Rural Health Clinics
1009 Duke Street
Alexandria, VA 22314
(202) 544-1880

Cost Report Impact of Chronic Care Management  not being an  Allowable Cost on RHC Cost Reports

If the costs are reported in Line 50 or a cost report line with similar properties specifically lines 50-60 (the red light of our traffic light analogy that I use in our seminars) of the Independent Cost Report (Form 222), the costs are being disallowed on the cost report and they are reducing the allowable overhead as well. This should   not   have a large impact on most independent RHCs as the average/mean cost per visit is around $124 per visit per the last NARHC/Wifli Benchmarking study that I have seen. Since the All Inclusive rate (AIR) cap is $81.32 there is a $43 dollar "cushion" per visit in the average/mean Independent RHC cost report, so very few RHCs would actually push their cost below the AIR cap. Those clinics at or just below the AIR cap would most likely have a lower AIR due to this treatment of expenses. For provider-based RHCs that are 49 beds or less and not subject to the AIR cap the math is a little more difficult as each dollar you allocate to the expense of chronic care management will directly lower your rate per visit. 

CMS is treating chronic care management similar to services like lab, hospital services, and technical components that are billed to Medicare Part B. This has a real chance to impact the ability of provider-based RHCs from providing these services due to the reduction in the AIR that this would create.

What RHCs need to know about National Health

 Service Corp Loan Repayment and Shortage 

Designations Webinar on April 19, 2016

Please register for What RHCs need to know about National Health Service Corp Loan Repayment and Shortage Designations on Apr 19, 2016 2:00 PM EDT at: 

Joseph N Lampard of HPSA Acumen will be our panelist and presenter for a webinar on what RHCs need to know about National Health Service Corp loans, HPSA designations, shortage areas and incentive payments based upon location for rural health providers. 

For information about HPSAs email at HPSA Acumen.

After registering, you will receive a confirmation email containing information about joining the webinar.

Brought to you by GoToWebinar®
Webinars Made Easy®

Youtube Channel with RHC Webinars

HBS has started a YouTube Channel and it has all the recordings of previous webinars on it. Here is the link:

  Recorded Webinars on RHC Billing, Cost Reporting, Certification, and Annual Evaluations  


Also visit our partners who are experts in various services related to RHCs and rural healthcare.
HPSA Acumen
National Health Service Corp Loan, HPSAs, and MUAs
Joseph Lampard
  (716) 483 - 0888
Rural Behavioral Health, LLC
Mental Health Services
Dave Jolly
(423) 243-6185
Heart Watch Wellness
Preventive,  Diagnostics,  & Weight Loss
Dan Hayes  
(615) 732-0768
AMS Software
RHC Software  and Services
Matt Kannan
(800) 440-6949
Care 24 / 7
Chronic Care Management
Huy Nguyen, MD
1 (800) 218-3780

Thank you for reading this newsletter and working with our partners in providing healthcare to rural underserved America. If you need any help with RHC cost reporting, annual evaluations, certifications, or seminars or webinars for RHCs, please let us know.

Mark R. Lynn, CPA (Inactive)
RHC Consultant
Healthcare Business Specialists
Suite 214, 502 Shadow Parkway
Chattanooga, Tennessee 37421
Cell Phone: 423-243-6185
Fax: (800) 268-5055