Rural Health Clinic (RHC)

On this page, view the below information.

Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10, Section 10.2.1.13

  • Considered to be Part B certified suppliers, even though they enroll in Medicare via the Form CMS-855A
  • Often enrolled congruently in Part A and Part B need both apps
    • This is not a requirement
  • Must be primarily engaged in furnishing outpatient services
  • Facility cannot be simultaneously enrolled as an FQHC and an RHC
  • RHCs are very similar to FQHC but there are key differences:
    • FQHCs can service rural or urban regions however RHCs may only service an area that: (1) is rural, and (2) contains a shortage of health services or qualified medical personnel (otherwise known as a "shortage area")
    • FQHCs furnish preventive services, RHCs do not
    • RHCs are surveyed by the state, FQHCs are not
  • RHCs must
    • Employ a nurse practitioner (NP) or physician assistant (PA)
    • Have a nurse practitioner (NP), physician assistant (PA) or certified nurse midwife (CNM) working at the clinic at least 50 percent of the time operated
    • Directly furnish routine diagnostic can laboratory services
    • Have arrangements with one or more hospitals to furnish medically necessary services that are not available at the RHC
    • Have available drugs and biologicals necessary for the treatment of emergencies
    • Furnish all the following laboratory tests on site
      • Chemical examination of urine by stick or tablet method or both
      • Hemoglobin or hematocrit
      • Blood sugar
      • Examination of stool specimens for occult blood
      • Pregnancy tests
      • Primary culturing for transmittal to a certified laboratory
    • Have an annual program evaluation
    • Post their days and hours of operations
    • Not be a rehabilitation agency or a facility that is primarily for the treatment of mental disease
    • Meet other applicable State and Federal requirements
  • Popular application seen with Noridian

Billing for RHC

  • For more information regarding billing, go to the billing portion of the website.

Application Requirements

PECOS application

  • "Institutional Provider" (e.g., Hospital, Skilled Nursing Facility, Hospice, Home Health Agency)
  • Complete questionnaire to ensure correct applications (CMS-855A and CMS 588-EFT) populate.

CMS-855A

  • Complete all form sections
  • Attach all supporting documentation such as IRS documents
  • List all directors, board members, and contracted or W-2 managing employee
  • Visit the Application Fee webpage to access CMS link to pay application fee

CMS-588 EFT

  • Submit completed CMS-588 EFT and voided check/bank letter. EIN required to be on application in Tax Identification Number (TIN) field
  • Must have the following attachments
    • Provider-Based Attestation Statement if they want to be provider-based to a hospital – Letter stating based to hospital ex: Joe's clinic based in Casselton would like to be associated/affiliated with Sanford. Initial done for each location wanting to be associated.
    • Sign a supplier agreement with CMS, form CMS-1561A
    • List all fixed locations, and include mobile sections if they provide any mobile services

Application Time Frame

Application Type Processing Time
PECOS On average, it can take 15 to 50 calendar days before application is sent to state and CMS for approval
Paper On average, it can take 30 to 65 calendar days before application is sent to state and CMS for approval

Note:

  1. Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the State Agency and CMS. There is no set timeframe for their review.
  2. Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.
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