Overcoming RHC Billing Challenges

1. Overcoming RHC Billing Challenges By: Joanie Perkins, CPC

2. Objectives • Participants will be able to: • Understand the differences between a provider based RHC and an independent RHC • Understand MSP regulations • Appropriately code/bill preventive services • Appropriately bill professional and technical components • Understand the importance of RAC

3. If you think you’re too small to make a difference, try sleeping in a closed room with a mosquitoAfrican Proverb

4. PBRHC – IRHC Differences • Provider Based RHC – Outpatient department of hospital / nursing home – RHC claims to TriSpan, all other claims under the “main provider number” • Independent RHC – Usually privately owned - RHC claims to Riverbend, all others to Carrier (Cahaba)

5. Medicare Secondary Payer Form • Must complete an MSP form each Medicare patient visit (revised 9/11/06) • CMS recommends providers retain a copy of the form for 10 years 20.2.1 • Audits are taking place currently in Mississippi • Medical record submissions and internal MSP policy and procedures are required upon request

6. Medicare Co-pays and Deductibles • 2009 Medicare Deductible for Part B stays the same at 135.00 • Collect 20% of your total charges

7. Revenue Codes As of April 1, 2005, RHCs are not required to report HCPCS codes on any line items billed with TOB 711 • 0521 Clinic visit in RHC. • 0522 Home visit. • 0780 Telehealth originating site facility fee. • 090X Psychiatric services.

8. Revenue Codes • Effective July 1, 2006: • 0524 Visit in a covered Part A stay in a Skilled Nursing Facility (SNF) Swing Bed (SB). • 0525 Visit in a non-covered SNF/SB or other residential facility. • 0527 Visiting nurse service in home health shortage area. • 0528 Visit to other non-RHC site (scene of accident).

9. Preventive Medicine in the RHC Welcome to Medicare Physical • G0344: New Medicare Physical • Face-to-Face Visit, services limited to “new” • Medicare beneficiary during the first 6 months of • Medicare Enrollment. • G0366: EKG; routine w/12 leads; • G0367: EKG tracing only • G0368: Interpretation & Report Only • Plus E&M 99211-99215 – 25 modifier – if provider addresses/manages new or pre-existing problems which will require a change in mgmt.

10. Billing Preventive Health for Medicare Beneficiaries • The Pap smear itself is not an RHC service it is a laboratory service. The obtaining of the specimen, is in fact an RHC service and should be billed as an RHC service. • The same with the cancer screening guidelines, consistent with Medicare's periodicity schedule the professional component of obtaining specimens or conducting cancer screening under Medicare guidelines is considered to be an allowable RHC service that's billed under the 52X revenue code. • laboratory functions or any diagnostic studies that are attentive to that will then be billed separately under part B or to the FI depending on the RHC status (independent or provider-based).

11. Professional/Technical Components • Bundle Professional fees • Break out TC file to Carrier (independent) or FI under the “main” provider number • EKG 93005 Riverbend or TriSpan • 93010 Bundle w visit

12. Labs • Labs done on-site • PBRHC bill under the “main provider” TOB 141 if specimen drawn in the RHC or 85X if patient presents to the CAH • Effective 7/1/09 all labs billed under 85X • Independent bill to carrier

13. 2009 RHC Rates • The RHC upper payment limit is increased 1.6% over 2008. The new Independent and Provider based upper payment limit (for providers over 50 beds) is 76.84 • Provider based clinics under 50 beds will be adjusted when the annual cost report is reviewed.

14. Recover Audit Contractors • IN contractor – CGI Technologies and Solutions, Inc. of Fairfax, VA • Program moving forward quickly • Teams should be assembled • Tracking software implementation (planning) • American Hospital Association • RacTrac • Software Vendors

15. Contact Info • Joanie.perkins@northsunflower.com • (662) 756-1703