RHC Update from CMS

RHC Update from CMS:

Coinsurance Correction for Certain RHC Claims – Effective April 1, 2016, Rural Health Clinics (RHCs) began reporting Healthcare Common Procedure Coding System (HCPCS) codes for all services furnished during the visit. CMS is aware that coinsurance may not be calculated correctly when RHC claims are submitted with multiple revenue lines for medical services. A system fix was implemented on May 9, 2016, to correct this issue. Your Medicare Administrative Contractor will adjust any claim processed incorrectly. No provider action is required.

Billing Requirements for RHCs – CMS understands that some Rural Health Clinics (RHCs) are unable to implement the billing requirements described in MLN Matters Article #9269 due to internal systems constraints. Contact your Medicare Administrative Contractor to find out if a temporary option is available while your system is updated.

Clarification on how the CG modifier will work, and how exactly to bill all those claims you are holding until Oct. 1. – In April 2016, CMS instructed RHCs to hold claims only for a billable visit shown in red on the RHC QVL until October 1, 2016. Upon billing these claims and/or for claim adjustments beginning on October 1, 2016, RHCs shall add modifier CG (policy criteria applied) to the line with all the charges subject to coinsurance and deductible. The subsequent paragraph explains modifier CG further. Beginning on October 1, 2016, the MACs will accept modifier CG on RHC claims and claim adjustments. RHCs shall report modifier CG on one revenue code 052x and/or 0900 service line per day, which includes all charges subject to coinsurance and deductible for the visit. For RHCs, the coinsurance is 20 percent of the charges. Therefore, coinsurance and deductible will be based on the charges reported on the revenue code 052x and/or 0900 service line with modifier CG. RHCs will continue to be paid an all-inclusive rate (AIR) per visit.The full article can be found here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1611.pdf


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