NARHC-News: p ublished quarterly                    Your RHC News Source                                            Spring 2016 Edition
Rural Health Clinics
CPT Code Reporting Is Here
The dawn of a new era is upon us. April 1, 2016 has come and gone and CPT/HCPCS code reporting is here to stay. As you probably know by now, this requirement constitutes a significant change in RHC billing. While we are happy to report that the Rural Health Clinic Technical Assistance Call on the reporting requirements set a record of over 900+ participants and 13,000 hits to the website (which I suppose can be a good or bad thing depending on how you look at it), there clearly was a lot of frustration and confusion surrounding these new rules. As such, we want to ensure you that the NARHC remains committed to:  
  • Working with CMS to improve and clarify this policy; and
  • Updating the RHC community on the latest guidance from CMS 
Let's start at the beginning...     read more  
Veterans Choice Act Stumbles Out of Gate
You may remember that in April, 2014, reports of negligence in the treatment of veterans by the Department of Veteran's Affairs emerged. FORTY VETERANS  died while waiting for care at the Phoenix, Arizona, Veterans Health Administration facilities. Additionally, an internal VA audit found that more than 120,000 veterans never got care because schedulers were pressured to mask the amount of time it took for veterans to get appointments, making wait times appear shorter on paper than they were in reality. This controversy drove both chambers of Congress to pass the Veterans Access, Choice, & Accountability Act of 2014 (Choice Act) by overwhelming margins which the President signed into law on Aug. 7th, 2014.
One of the key provisions of the Choice Act allowed veterans who are unable to schedule an appointment within 30 days, or who live more than 40 miles away from the closest VA facility the option to receive care from certain non-VA health care providers such as Rural Health Clinics. The legislation was an expansion of what is sometimes referred to as "purchased care" or "community care" programs.  
read more
Mark Your Calendar...
NARHC 2016 Fall Institute

The RHC Conference --   App. 17 Breakouts, 24 Sessions
SESSIONS BEING CONSIDERED:  Pre-Conference Morning (for those new to the RHC world);  Legislative Issues; Latest Billing and Cost Reporting (Beyond The Basics); Chronic Care Management;  ICD-10 Refresher; Requirements for Medical Records; Personnel Issues with the Multi-Generational Divide;  Successful Mgm Strategies for a Hospital-Owned Med. Practice; PCMH Standards; Leadership in the RHC;  RHC Clinical Documentation & Coding: A Workflow Analysis; PBs & Independents: Are We Compliant;  Medical Staff Credentialing; Improving Your Revenue Cycle; Getting Value from Your Back Office;  Reimbursement Pitfalls; Using Technology to Engage with Patients & Improve Outcomes; etc.    

Room rates begin at $79 a night for a 4 star hotel (no kidding)!  Register EARLY for the conference & your room in the "NARHC" room block for the best rates. The block fills up a month in advance! 
Registration will open at the end of May  on the NARHC  website, click HERE Like us on Facebook to see pictures of the Spring Institute click HERE.   
Funding Opportunity

THE KATE B. REYNOLDS CHARITABLE TRUST is excited to announce  the 2016 New Rural: Innovations in Rural Health Award. We are seeking original, innovative solutions that have the potential to drive health improvement in rural communities.

These don't have to be finalized projects--we encourage submissions from around the country that highlight new ideas and emerging work. Individuals, for-profits, nonprofits and government agencies are welcome to apply. Finalists will receive a $7,500 award and one innovative & inspiring idea will win the New Rural Award and a total of $25,000. Hurry!  The deadline is April 29.   read more  
Ron Nelson Award Nominations Sought
NARHC Members are invited to submit NOMINATIONS for a worthy recipient of the Ron Nelson Award. This award recognizes and honors an outstanding leader and promoter of Rural Health Clinics. Please nominate an individual who has dedicated their time and talent to advancing the health and well being of others through the RHC program. Persons doing the nominating do have to be NARHC members but award recipients do not have to be NARHC members. 

This sign of our appreciation and national distinction will be awarded in Reno at the NARHC Annual Meeting on October 19, 2016. Nominations will be accepted until May 31st. If you know of someone worthy of our recognition, please take a moment to fill out the nomination form.     read more  
Accelerated Payments Possible
for Hardship

What follows is a condensed version of a Q & A that occurred recently where Captain Corinne Axelrod gave advice to one clinic for whom the October 1st hold date would be a hardship...
Question:  The majority of our Podiatrist's RHC visits are procedures which occur without a face-to-face visit. This encompasses 31% of our clinic's RHC claims in the fiscal year.  Must we still wait until October 1st to bill those?
Answer:  We looked into this and have been informed that all of the MACs can make accelerated payments if they determine that a hardship would occur if payment is not made.  We do not have to approve it & we are not informed if it occurs--it would be an arrangement between the facility & the MAC. read more  
2016 Medicare Symposiums

Registration is available via the Novitas Medicare Learning Center at this link, click HERE. You must have a learning center account to register.

April 13 - Scranton, PA
Radisson Lacawanna Station Hotel, 700 Lackawanna Avenue, Scranton, PA 18503

May 12 - Wilmington, DE
DoubleTree by Hilton Wilmington, 4727 Concord Pike, 
Wilmington, DE 19803

See all 8 Dates and Locations...     read more  
Minors Rights and HIPAA


Under HIPAA, minors do not have full legal rights are are represented by a parent or guardian in the law until they reach the age of majority. HIPAA gives parents right to full disclosure to their child's medical information in most cases and to make medical decisions for the minor on their behalf. At first glance, this would seem to go against the strong privacy rules of HIPAA, but as minors are not seen as competent to manage their own medical care under the law, parents act as their representative.


However, there are also many situations where a parent or guardian does not have a legal right to the medical information of a minor. A parent have the option to waive their right to their child's medical care when the child and their care provider have a consented private relationship.   read more
New & Excluded Revenue Codes
If you haven't realized it yet, we rural health clinics are strange creatures, which is why we often feel as if we live in a ZOO. The new CMS billing changes, effective April 1st, have added to our craziness. Let me explain. 

We typically think of ourselves as clinics, but technically we are considered facilities or institutions because of our certification and funding types.  Hence, we bill on the UB-04 for our Medicare claims in the same way that a hospital would bill. For hospital billing, revenue codes are an everyday thing. For us, they are new and scary territory!   Before the CPT® code requirement, we had learned to cookbook the claims format because it was pretty simple given our handful of revenue codes. Now, we are faced with reporting CPT® and HCPCS® codes with the  correct corresponding revenue code. (CPT® codes are a subset of HCPCS® codes, but I am using both terms.)      read more
Chronic Care Management (CCM) Services

January 1, 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (MPFS) and the Outpatient Prospective Payment System (OPPS) for the AMA's CPT code 99490 for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. These services have been overlooked by many hospitals as a "professional-only" service, thus missing a revenue opportunity (hard to find in the world of Medicare payments). Although CMS does not recognize CCM as an RHC or FQHC service, an RHC or FQHC may have the opportunity to bill for CCM on the Medicare Physician Fee Schedule, provided it satisfies the applicable billing requirements for non-RHC/non-FQHC services.

CMS pays the following for CCM services:
  • PPS Hospitals: 2016 Medicare APC Rate
  • CAH Hospitals: 2016 Outpatient Interim Rate
  • RHCs: 2016 Average National Non-Facility MPFS
read more  
Sports Physicals

During this time of year and on into the summer months, one of the questions being asked is how do we handle "sports physicals"?  With all that is dependent upon the sports physical, RHCs need to consider doing the annual physical at this time.   Most insurance companies pay for an annual physical as well as State Medicaid pays for the annual physical if all the components of a physical are completed.  

Clinics need to weigh the risk involved in the type of physical that is being completed.  Many times this is the only time these kids come to the clinic for services and the Clinic should address many other concerns with the kids and use this time as a "teaching moment" for these kids.     read more  

Before you consider purchasing prescription medicines from an online pharmacy, especially one that's not associated with a health insurance plan or local "brick and mortar" pharmacy, check out FDA's BeSafeRx - Know Your Online Pharmacy website and resources. 

Fraudulent online pharmacies can manipulate their websites to appear legitimate, so FDA recommends you always confirm that an online pharmacy is licensed in the United States. Fake online pharmacies use sophisticated marketing efforts or phony web storefronts to appear legitimate.        read more  
In This Issue
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