2017 NARHC-News                       Your RHC News Source                    Winter 2018 Edition
CMS Releases New 
Survey & Certification Guidance
SOM Appendix G Expanded from 24 to 90 Pages but Adds Burden

On January 26th, the Centers for Medicare & Medicaid (CMS) released a new version of the State Operations Manual Appendix G - Guidance for Surveyor: Rural Health Clinics. This updated version has significantly more detail than its predecessor as evidenced by the increase in page count from 24 to 90. I would recommend all RHCs with upcoming surveys review the document in its entirety.
While this new version does include a lot of helpful and benign clarifying language, we (NARHC) were disappointed to see that CMS did not take this opportunity to reduce regulatory burdens on RHCs.  
Read More
RHC Billing Technical Assistance Call
NARHC and HRSA offer you these webinars FREE of charge!

The next RHC TA webinar is scheduled for Thursday, February 22, 2-3 PM (Eastern time).  The topic is RHC Billing.
The webinar will be conducted jointly by Shannon Chambers, Director of Provider Solutions with the South Carolina Office of Rural Health, and Janet Lytton, Director of Reimbursement with RHD, Inc. Janet and Shannon will cover some of the most common RHC billing topics and then we will leave time for audience questions.    Read More
National Advisory Committee on 
Rural Health & Human Services
Recommends Provisions to Modernize the RHC Program

The National Advisory Committee on Rural Health and Human Services (the Committee) is a nationally recognized panel of rural health experts that provides recommendations on rural issues to the Secretary of the Department of Health and Human Services. Recently, they released their report on how to "modernize rural health clinics".
This report creates an opportunity for NARHC and the broader RHC community to press policymakers for RHC modernization. Generated by an unbiased panel of health experts, this report confirms many of the policies we were already advocating for, and provides additional evidence to help make the case.    Read More
Time is Short!  Rates Increase Feb. 17
Hyatt Regency Riverwalk -  San Antonio, TX

Mar. 19-21, 2018 (Mon.-Wed.)
A Conference "for & about" RHCs!

23 Speakers,  21 Sessions, 10 Breakouts
Featuring Capt. Corinne Axelrod from CMS!

PRECONFERENCE:  RHC Basics & Beg. Billing; Cost Report Basics; Compliance Basics.
CONFERENCE: Emergency Preparedness Risk Assessment;  Care Management; Legislative Update; Putting It All Together: Annual Meeting + Emergency Plan; RHC Round Tables with the Experts; Advanced Billing; Leading through Change while Removing Misery from Your Practice; PCMH & Other Innovations; HIPAA Case Studies; Advanced Cost Reporting; Docu-ment & Select Outpatient Levels of E&M Services; Building Your RHC Quality Program; Policy & Procedure Manual; MAC Discussion: Novitas; How RHCs Fit in a Regional Health Network; Develop Your Practice Management Toolbox; Texas Session; Audit Your Practice Like a CPA.

Room rates begin at $185/night!  Block closes Feb. 26!    Read More   
Trump State of the Union Speech
Individual mandate repeal, drug prices, opioids

President Donald Trump touched on a number of healthcare issues in his State of the Union speech but did not echo his regular refrain for a full repeal of the Affordable Care Act.  He touted Congress' rollback of the individual mandate in the address, calling the measure, which was intended to push people to get health insurance, "an especially cruel tax" on some of the poorest Americans. "We repealed the core of the disastrous Obamacare. The individual mandate is now gone," Trump said. "Thank heaven." The GOP-controlled Congress tried multiple avenues to cut other elements of the ACA, but those efforts came up short. Trump has characterized the individual mandate repeal, which was passed as part of a tax reform package, as "essentially" repealing the law. Senate Majority Leader Mitch McConnell, R-Ky., has indicated that he is ready to move on from an ACA repeal, though not all of his peers agree.   Read More
New Medicare Card: 
Less Than Two Months until Transition Begins

On April 1, 2018, CMS will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to everyone with Medicare. The MBI will replace the Social Security Number (SSN)-based Health Insurance Claim Number for transactions like billing, eligibility status, and claim status after a  transition period

You must be ready to accept the MBI beginning April 1. People new to Medicare after April 1 will only get a card with the MBI.      Read More
NARHC's Certified RHC Professionalâ„¢
(CRHCP) ONLINE TRAINING with In-Person Exam in Lake Tahoe

MARK YOUR CALENDAR: Registration opens on June 27  for NARHC's online course designed to teach Clinic Directors, Administrators, and other RHC Professionals how to run a successful RHC!  We will accept the first 100 who register and pay beginning June 27. We filled up in 4 days last time.
This 6-8 week course may be taken at your convenience (nights, weekends, etc.) as long as the coursework is completed before you attend the 2018 NARHC Fall Institute.  Those with no prior experience may need 8 weeks.  An in-person exam is scheduled in Lake Tahoe on the last day (afternoon) of the conference (Thurs., Oct. 25). The coursework is broken into 4 modules with optional videos & pre-tests at the end of each: 
  • Administration & Finance
  • Billing & Coding
  • Human Resources
  • Regulatory Compliance & Quality         Read More

What to Do When the  State Surveyor Arrives

Take a deep breath, relax, answer questions when asked and don't offer information not requested.  The only item you should offer if not asked for it, is the Annual Evaluation Report (item #1 on the list below).  Generally, state surveyors are not trying to take away your RHC certification, but rather to make sure you operate according to the regulations.  While we still have areas of the survey that are "open to the interpretation of the surveyor", most of the requirements have very specific Federal Regulations backing them up.
Do not offer to take the surveyor to lunch or to buy them lunch and bring it to them.  Offer them a bottle of water or similar beverage, a desk to work from and access to a phone.  The surveyor should not expect to walk thru the clinic without being escorted by the office manager.  Do not correct the surveyor even if you think they are wrong.      
     Read More
How Can Your RHC Stay Competitive?
Transforming Our Clinics to be Excellent

Have you looked around lately?  Have you taken stock? Is there a new walk-in clinic in your service area? Are you having an increase in no-shows?   In the RHC economy we are concerned about the allowable costs of providing care and the number of face-to-face encounters, right?  Our cost-based reimbursement does help us keep our heads above water, but it does very little in helping us stay competitive and preventing outmigration. Outmigration happens when our patients leave our rural service area to seek care in a larger adjacent market. One reason is because we as the RHC community aren't staying relevant.  We love our communities and are committed to them, but we don't realize that our patient demographics and the expectations of our patients are changing.  How can we be more competitive?      Read More
EP's Not Going Away
Emergency Planning for Rural Health Clinics

Gloom frequently is the descriptive term for weather throughout the year, or at least a self-prescribed portrayal by all of us expert, amateur meteorologists. The past few months, gloom has transitioned beyond weather, although none of us escape the irony that weather is acutely entrenched in the new source of this gloom. We all assumed...hoped...maybe even prayed it would go away, while a deafening percentage seemed to ignore the emergency preparedness regulations. 

Maybe it just got away from many of us, as fast-paced, demanding days turned into months, turned into years, turned into... 'Oh darn!' I DID say years by the way! This regulation has been in the works that long, actually becoming effective in 2016!! Since November 2017, surveyors are asking about elements of the regulation like emergency plans, hazard vulnerability assessments, policies, exercises and documentation of training for all of it! As it turns out...ignorance is not bliss.     Read More
Tips for Finding Executive Talent for 
Rural Healthcare Providers

The following scenario is one that any rural health care provider dreads but is crucial for the organization to carefully consider as it plans for the future.
The CEO resigns. He has been with the hospital/clinic for many years. The governing Board of Directors is taken by surprise at the resignation. The Board was so comfortable with the CEO that it never planned for new leadership. Simply put, there is no succession plan.
With the departure of a CEO or other C-suite executive, an organization faces difficult challenges in finding a top-talent replacement.     Read More
In This Issue
Quick Links
Upcoming Events
NARHC 2018 Spr Institute
Mar. 19-21, 2018 (M-W)
Hyatt Regency Riverwalk
San Antonio, Texas
Click here for  more info  .
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