Wiki Rural Health Billing

[kreish]

I am new to Rural Health billing and need help determining if certain codes fall under Medicare Part a or Part B under Rural Health care guidelines. Specific codes are J3488 / Reclast, and J0885/ Epogen. Per Rural Healthcare guidelines--there are a number of professional services that would normally fall under Part B that are to be billed to Part A. We have been unable to find any rules with regards to these 2 services. Also--we have several cases where the patient is being seen for an immunization or injection service, or lab and no office visit is billed--can the service still be considered an encounter? Thanks in advance for any help with this issue!!!

 

[carynsmith]

Hi Kreish,

RHC guidelines are much like FQHC guidelines. By definition an encounter is a "face to face" visit between the physician and the patient. Any service that the physican performs can be considered an "encounter" and should be billed to Medicare Part A. CPT's 99201-99215, Wellness codes: 99384-99397, In office procedures [excluding the G0101], and Nursing home charges fall under the face to face encounter. By billing these codes to Part A your company will recieve their RHC enhancement payment. What you will need to bill to Part B are: Injections, xrays, Hospital services and other ancillary services, as these are not considered an encounter and sholuld be billed to Part B.

I hope this helps,

Caryn Smith, CPC

 

[kimlee]

I am the billing manager for an FQHC which has simliar guidelines as rural health. I would verify the following w/ CMS-- but w/ an FQHC many services CANNOT be billed out to Part B and must performed at a zero charge and many are included in your cost report. Such as the flu shot and pnuemovax.

For Hospital services there is no reimbursement either, as CMS clearly states the fee for these is covered in your threshold rate. I have attended several conferences where this comes up and creates quite the ruckus.