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A Rural Health Clinic (RHC) is a clinic located in a rural underserved area with a shortage of primary care providers personal health services or both Currently there are about 4500 RHCs nationwide providing primary care and preventive health services in underserved rural areas RHC Practitioners

PDF Saint Mary’s Occupational Health Center

56 Franklin Street • Waterbury CT 06706 • 203-709-6000 • stmh Saint Mary’s Occupational Health Center 1312 West Main St Waterbury CT 06708 (P) 203-709-3740 (F) 203-709-3741 New Employee Occupational Health Packet The enclosed packet was designed to expedite your Urine Drug Screen and Pre-employment Physical

How Do I Get Certified as An RHC?

Determine if your clinic is eligible – See Are there location requirements for RHCs?for information about location requirements. Complete the RHC application and the Centers for Medicare & Medicaid Services (CMS) provider enrollment form – Contact your state agency responsible for RHC certification for an RHC application packet. The CMS-29, Verific

Are There Any Other Considerations Before Becoming An RHC?

Completing a financial assessment may be helpful to see if becoming a certified RHC is a feasible option and to understand the advantages and disadvantages of becoming an RHC. The financial benefits of RHC status depend on the mix of payers and services offered. Traditional Medicare fee-for-service and state Medicaid provider rates will vary. When

What Is The Difference Between A Provider-Based RHC and An Independent RHC?

Provider-based RHCsare owned and operated as an essential part of a hospital, nursing home, or home health agency participating in the Medicare program. RHCs operate under the licensure, governance, and professional supervision of that organization. Most provider-based RHCs are hospital-owned. Independent RHCsare free-standing clinics owned by a pr

Are There Location Requirements For RHCS?

Yes. According to statute, RHCs must be located in non-urbanized areas, as defined by the U.S. Census Bureau. However, beginning in March 2022, the U.S. Census Bureau published updated criteria informing how it will define urban areas based on the results of the 2020 Decennial Census, including no longer defining or differentiating between urbanize

Are There Special Staffing Requirements For RHCS?

Yes. An RHC must: 1. Employ at least one nurse practitioner (NP) or physician assistant (PA) 2. Have an NP, PA, or certified nurse midwife (CNM) working on-site to see patients at least 50% of the time the clinic is open. Other staff may work under contract. Every RHC must be “under the medical direction of a physician” who is an MD or DO, but the

What Resources Are Available to Help Rhcs Maintain Their Primary Care Workforce?

Several resources and grant programs help recruit and retain physicians and mid-level practitioners: 1. 3RNET (National Rural Recruitment and Retention Network)helps rural healthcare organizations attract healthcare providers by posting job opportunities online by state. Candidates who are interested in working in rural areas may register with 3RNe

How Does Medicare Reimburse RHCS?

Medicare pays RHCs 80% of a flat, all-inclusive rate (AIR) for medically necessary medical and qualified preventive visits delivered on the same day; the remaining 20% is charged to patients as coinsurance. The AIR is subject to payment limits, meaning an RHC will not be paid beyond the prospectively set limit, regardless of the actual cost of the

How Do States Reimburse Rhcs Through Medicaid?

All state Medicaid programs are required to recognize RHC services. The states may reimburse RHCs under one of two different methodologies as outlined in a 2016 CMS letter to state health officials: 1. Prospective payment system (PPS)– Under this methodology, the state calculates a per visit rate based on the reasonable costs of the services provid

Can Rhcs Be Reimbursed For Telehealth Services?

RHCs can be an “originating site” for telehealth services. An originating site is the location where an eligible patient gets telehealth services with a provider in a different location. RHCs serving as an originating site can bill Medicare for an originating site facility fee. In response to the COVID-19 pandemic, Congress passed the Coronavirus A

How Does The Merit-Based Incentive Payment System (MIPS) Affect RHCS?

RHC services are exempt from the Merit-Based Incentive Payment System (MIPS) because MIPS applies to payments made through the Physician Fee Schedule. The Quality Payment Program(QPP) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MIPS is one of two tracks within the QPP designed to provide incentives for high qual

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