Rural Health Clinics (RHCs)
A. General Background Information
Rural health clinics (RHCs):
• Are considered to be Part B certified suppliers, even though they enroll in Medicare via the Form CMS-855A.
• Must be primarily engaged in furnishing outpatient services. However, the services can, in certain instances, be performed in locations outside of the four walls of the clinic. (See CMS Pub. 100-02, chapter 13 for more information.)
There are certain services performed by RHCs that do not actually qualify as RHC services. To bill for these services, the clinic must enroll as a Clinic/Group Practice via the Form CMS-855B. It is not uncommon to see RHCs simultaneously enrolled in Medicare via the Form CMS-855A (to bill for RHC services) and the Form CMS-855B (to bill for non-RHC services).
• Sign a supplier agreement with CMS (akin to those signed by certified providers). Specifically, RHCs sign the Health Insurance Benefit Agreement (Form CMS-1561A).
• Can be either mobile in nature or fixed/permanent locations.
Note that a facility cannot be simultaneously enrolled as an FQHC and an RHC. Though there are similarities between these two supplier types, there are key differences as well:
• Unlike FQHCs, which can service rural or urban regions, an RHC 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”). (See Pub. 100-02, chapter 13, section 10, which states that RHCs are clinics located in areas that are designated by (1) the Bureau of the Census as rural, and (2) the Secretary of the Department of Health and Human Services or the State as medically underserved.)
• FQHCs furnish preventive services. RHCs do not.
• RHCs are surveyed by the State. FQHCs are not.
B. Additional RHC Information
For more information on RHCs, refer to:
• Section 1861(aa)(1-2) of the Social Security Act
• 42 CFR Part 491, subpart A
• Pub. 100-07, chapter 2, sections 2240 – 2249 (State Operations Manual)
• Pub. 100-04, chapter 9 (Claims Processing Manual)
• Pub. 100-02, chapter 13 (Benefit Policy Manual)
For guidance on the appropriate contractor jurisdictions for incoming RHC applications, refer to:
• Pub. 100-04, chapter 1, section 20
• Pub. 100-04, chapter 9, section 10.3
A. General Background Information
Rural health clinics (RHCs):
• Are considered to be Part B certified suppliers, even though they enroll in Medicare via the Form CMS-855A.
• Must be primarily engaged in furnishing outpatient services. However, the services can, in certain instances, be performed in locations outside of the four walls of the clinic. (See CMS Pub. 100-02, chapter 13 for more information.)
There are certain services performed by RHCs that do not actually qualify as RHC services. To bill for these services, the clinic must enroll as a Clinic/Group Practice via the Form CMS-855B. It is not uncommon to see RHCs simultaneously enrolled in Medicare via the Form CMS-855A (to bill for RHC services) and the Form CMS-855B (to bill for non-RHC services).
• Sign a supplier agreement with CMS (akin to those signed by certified providers). Specifically, RHCs sign the Health Insurance Benefit Agreement (Form CMS-1561A).
• Can be either mobile in nature or fixed/permanent locations.
Note that a facility cannot be simultaneously enrolled as an FQHC and an RHC. Though there are similarities between these two supplier types, there are key differences as well:
• Unlike FQHCs, which can service rural or urban regions, an RHC 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”). (See Pub. 100-02, chapter 13, section 10, which states that RHCs are clinics located in areas that are designated by (1) the Bureau of the Census as rural, and (2) the Secretary of the Department of Health and Human Services or the State as medically underserved.)
• FQHCs furnish preventive services. RHCs do not.
• RHCs are surveyed by the State. FQHCs are not.
B. Additional RHC Information
For more information on RHCs, refer to:
• Section 1861(aa)(1-2) of the Social Security Act
• 42 CFR Part 491, subpart A
• Pub. 100-07, chapter 2, sections 2240 – 2249 (State Operations Manual)
• Pub. 100-04, chapter 9 (Claims Processing Manual)
• Pub. 100-02, chapter 13 (Benefit Policy Manual)
For guidance on the appropriate contractor jurisdictions for incoming RHC applications, refer to:
• Pub. 100-04, chapter 1, section 20
• Pub. 100-04, chapter 9, section 10.3
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