Rural Health Clinic (RHC) - JE Part A
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
Application | Tips |
---|---|
PECOS application |
|
CMS-855A |
|
CMS-588 EFT |
|
- 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:
- 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.
- Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.