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Mississippi Rural Health Association

Mississippi Rural Health Association. Advanced Billing for RHCs By: Joanie Perkins, CPC. Objectives. ► Understand what can be bundled ► What services qualify for RHC ► How to bill hospital services ► How to bill preventive services. Objectives. ► How to bill Diabetic Education

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Mississippi Rural Health Association

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  1. Mississippi Rural Health Association Advanced Billing for RHCs By: Joanie Perkins, CPC

  2. Objectives ► Understand what can be bundled ► What services qualify for RHC ► How to bill hospital services ► How to bill preventive services

  3. Objectives ► How to bill Diabetic Education ► How to bill Mental Health Services ► Claims Submission ► DDE (Direct Data Entry)

  4. 99211 Office Visits ► E/M code 99211 is commonly used for nursing visits, (injection administration, etc.), even though physicians sometimes bill them.

  5. 99211 Office Visits ► For RHC purposes, these are NOT considered encounters. ► They are often reimbursed for commercial payers.

  6. More on 99211 ► If a service is a 99211 and performed by a nurse, it does not qualify as an encounter.

  7. More on 99211 ► If it was performed by a provider: a. It could be under-coded b. The service does not require the expertise of a provider (not medically necessary)

  8. Hospital Services ► Physician services at the hospital are billed to Novitas Medicare Part B for fee-for-service reimbursement.

  9. Hospital Services ► If the parent-entity of the provider based RHC is a Critical Access Hospital (CAH) using option II billing-out-patient hospital services are billed to the parent’s FI.

  10. Preventive Services ► Medicare Preventive Services are partially payable as encounters.

  11. Preventive ServicesInclude ► Welcome to Medicare Physical ► Screening Pay/Pelvic Exam ► Cardiovascular Screening

  12. Welcome to Medicare Physical ► The professional component for covered preventive services are payable as an RHC encounter.

  13. Welcome to Medicare Physical ► Diagnostic tests will be billed to the Part B carrier or Hospital FI. ► Only payable once per lifetime.

  14. Welcome to Medicare Physical ► Deductible and Co-Insurance do not apply. ► Must be completed within 12 months of Medicare entitlement.

  15. Other Preventive Services ► The professional component for the biennial screening pap/pelvic exam can be billed as an encounter. The labs will be billed to the carrier or hospital FI.

  16. Other Preventive Services ► All diagnostic tests for the cardiovascular screening are billed to the Part B carrier or Hospital FI.

  17. Other Preventive Services ► Encounters that are normally non-covered with Medicare part B are not covered under RHC.

  18. Diabetic and Nutrition Counseling ► These are incident to the physician or mid-level services. Bundle them into the charge.

  19. Diabetic and Nutrition Counseling ► These cannot be billed to the Medicare Part B carrier and by themselves do not qualify as an encounter.

  20. Diabetic and Nutrition Counseling ► The costs for these services are included in the cost report.

  21. Mental Health Services ► Mental Health Services performed by a qualified provider are billed using revenue code 900.

  22. Mental Health Services ► Diagnostic services are paid as an encounter. ► Therapeutic services are subject to a 62.5% payment limitation.

  23. Claim Submission ► Visits with more than one RHC professional on the same day are one encounter. ► TriSpan will allow an RHC encounter and a hospital admission on the same day.

  24. Claim Submission ► Theoretically, two encounters on the same day but for different diagnoses are payable.

  25. Claim Submission ► An RHC encounter and a mental health visit on the same day are payable

  26. Revenue Codes The following revenue codes are used on UB04 claims: ►0521 clinic visit at RHC by qualified provider

  27. Revenue Codes ►0522 Home visit by RHC provider ►0524 Visit by RHC provider to a Part A SNF bed

  28. Revenue Codes ►0525 Visit by RHC provider to a SNF, NF or other residential facility (non-Part A).

  29. Revenue Codes ► 0527 Visiting nurse service in home health shortage area. ►0528 Visit by RHC provider to other non-RHC site (scene of accident)

  30. DDEDirect Data Entry ► Work returned claims electronically. ► Access to the Common Working File for beneficiary eligibility and benefits.

  31. DDEDirect Data Entry ► Correct and enter claims online. ► Review status of suspended, pended, and paid claims.

  32. RHC Resources ► NARHC List Serve – just remember, it’s public and you can’t discuss setting fees.

  33. RHC Resources ► Riverbend www.rgbagov.com ► Riverbend LCD http://www.rgbagov.com/ publications/lcd/lcd-files/4874.html*

  34. More Resources ►Main Site www.cms.hhs.gov ►Online Manuals www.cms.hhs.gov/Manuals/IOM/list.asp?listpage=1 ►CMS Rural Health Center www.cms.hhs.gov/center/rural.asp

  35. Contact Information Joanie Perkins, CPC (662) 756-1703 Joanie.perkins@northsunflower.com

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