News & Tips 

RHC/ FQHC rates updated by Transmittal 2406

02/10/2012 -

The 2012 RHC/FQHC rates  have been updated by Transmittal 2406  dated January 30, 2012.  This transmittal rescinds and replaces Transmittal 2343 dated November 4, 2011 that provided the 2012 rates.  The corrected rates issued by CMS on January 30, 2012 with Transmittal 2406 corrects the rates for the Medicare Economic Index for the productivity adjustment used in determining the RHC/FQHC upper payment limits.  The corrected rates issued on January 30, 2012 are outlined below.  While the effective date is January 3, 2012, the Medicare Contractors should not retroactively adjust individual RHC/FQHC bills paid at the upper payment limit.  To read more click here

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Bill Finerfrock, NARHC, discuss the advantages of being a RHC.

01/28/2012 -

First, as an RHC advocate, I’m not necessarily an unbiased resource but I think there are some advantages to being an RHC but those advantages may not be apparent or existent for everyone.

The RHC program is not for everyone and depending upon a practices payer mix and patient/community demographics, it may not be right for some folks who are currently in the program.  Everyone must evaluate the appropriateness of the RHC program on a case-by-case basis.  I don’t know the unique characteristics of your practice or any other practice so my observations are general in nature.  To read the full discussion click here.

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2012 Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases

11/07/2011 -

CMS released Change Request 7533 dated November 4, 2011 with the 2012 Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases

Effective Date: January 1, 2012; Implementation Date: January 3, 2012

Background:

RHCs:

The RHC upper payment limit per visit is increased from $78.07 to $79.48 effective January 1, 2012, through December 31, 2012 (i.e., CY 2012). The 2012 rate reflects a 1.8 percent increase over the 2011 payment limit in accordance with the rate of increase in the Medicare Economic Index (MEI) as authorized by §1833(f) of the Social Security Act.

FQHCs:

The FQHC upper payment limit per visit for urban FQHCs is increased from $126.22 to $128.49 effective January 1, 2012, through December 31, 2012 (i.e., CY 2012), and the maximum Medicare payment limit per visit for rural FQHCs is increased from $109.24 to $111.21 effective January 1, 2012, through December 31, 2012 (i.e. CY 2012). The 2012 FQHC rates reflect a 1.8 percent increase over the 2011 rates in accordance with the rate of increase in the MEI.

Policy:

This effective date of January 3, 2012, is necessary in order to update RHC and FQHC payment rates in accordance with §1833(f) of the Social Security Act. To avoid unnecessary administrative burden, the contractor shall not retroactively adjust individual RHC/FQHC bills paid at previous upper payment limits.  The contractor does, however, retain the discretion to make adjustments to the interim payment rate or a lump sum adjustment to total payments already made to take into account any excess or deficiency in payments to date.

The full Change Request can be viewed at https://www.cms.gov/transmittals/downloads/R2343CP.pdf

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Are You Submitting a Handwritten Medicare Enrollment Application?

05/26/2011 -

Medicare enrollment application forms are fillable on your computer.  This means that you can fill out the information required by typing into the open fields while the form is displayed on your computer monitor.  Filling out the forms this way before printing, signing and mailing means more easily-readable information – which means fewer mistakes, questions, and delays when your application is processed.  Be sure to make a copy of the signed form for your records before mailing.  Read more...

Our consultants at Matheney Stees and Associates are available to assist you in the preparation of your form 855.  We have experience with all provider types and would appreciate the opportunity to serve you.

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Medicare Enrollment Fee Payment

03/24/2011 -

How Institutional Providers Will Pay the Medicare Enrollment Application Fee beginning Friday, March 25

 

Section 6401(a) of the Affordable Care Act (ACA) requires the Secretary to impose a fee on each “institutional provider of medical or other items or services and suppliers.”  The fee is to be used by the Secretary to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes, including those under section 1866(j) and section 1128J of the Social Security Act.  The application fee is $505 for CY2011; based upon provisions of the ACA this fee will vary from year-to-year based on adjustments made pursuant to the Consumer Price Index - All Urban Consumers (CPI-U).  The application fee is to be imposed on institutional providers that are newly-enrolling, re-enrolling/re-validating, or adding a new practice location, for applications received on and after Friday, March 25, 2011.  CMS has defined “institutional provider” to mean any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S forms or associated Internet-based PECOS enrollment application. 

Read more

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