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Thread: Rhc billing for a protime

  1. #1

    Default Rhc billing for a protime

    AAPC: Back to School
    We are a rhc facility. We bill medicare part a but our claims are processed and paid by part b. We bill all encounters with the 521 revenue code. We currently bill a 99211 code for protimes - a patient comes in the nurse checks their blood (by finger stick) contacts the dr and adjusted the meds per dr order. This meets the requirements for an "incident to" visit and is in compliance with medicare part b standards. Does this rule apply to us because we bill medicare part a but are paid by part b? I am hoping to find someone that can clarify this issue for me. Are we billing these correctly? Please contact me by phone at (435) 381-2305. Thank you, kelly

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    Incident to applies only to the physician bill. It does not apply to the facility. A 99211 for the facility is dependent on your facilty guidelines for what constitutes a 99211.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Madison Wisconsin


    We are an FQHC facility and in order to bill an E/M including the 99211 the pt has to be seen face to face by a core provider and an RN, LPN or MA does not meet that requirement. The only thing we would be able to bill would be the the test itself and that would be sent to the part b in our situation Noridian for payment. I think the RHC falls under the same guidelines. check out http://www.ugsmedicare.com/Training/RHC.asp

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