What is the Medicare Benefit Policy Manual?

What is the Medicare Benefit Policy Manual?

The Medicare Benefit Policy Manual, also known as Publication 100-02, is an online-only reference for Medicare health care providers. This official government document details specific rules and regulations that govern the Medicare program.

How Does Medicare pay rural health clinics?

Medicare pays RHCs a bundled payment, or All-Inclusive Rate (AIR), for qualified primary care and preventive health services provided by an RHC practitioner. The AIR is calculated by MACs, and must be below a maximum amount established by Congress.

Are RHC claims split billed to Medicare?

Typically, hospitals and RHCs bill charges to Part A Medicare on a UB-04 form.

How do I bill Medicare for FQHC?

For FQHCs, payment is applied to the service line with revenue code 052X and a valid evaluation and management (E&M) HCPCS code for medical visits and revenue code 0900 for mental health visits.

How many preventive physical exams does Medicare cover?

A person is eligible for one initial preventive physical examination (IPPE), also known as a Welcome to Medicare physical exam, within the first 12 months of enrolling in Medicare Part B. Medicare enrollment typically begins when a person turns 65 years old.

What are Medicare benefits?

The Parts of Medicare Social Security enrolls you in Original Medicare (Part A and Part B). Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.

What is a Medicare rural health clinic?

An RHC is a clinic that is located in a rural area designated as a shortage area, is not a rehabilitation agency or a facility primarily for the care and treatment of mental diseases, and meets all other requirements of 42 CFR 405 and 491.

Why are rural health clinics important?

Rural hospitals increase local access and allow patients to focus on “getting better” rather than “getting to appointments.” Through connectivity and collaboration rural hospitals are large enough to serve our community’s health needs, but we are also small enough to care.

How do you bill RHC?

RHC services must be billed with the below RHC revenue codes and a Healthcare Current Procedural Coding System (HCPCS) code descripting the encounter:

  1. 0521 – Clinic Visit by member to RHC.
  2. 0522 – Home visit by RHC practitioner.

What is a split claim?

Dividing a single or indivisible claim or cause of action into separate parts and bringing separate suits upon it, either in the same court , or in separate courts or jurisdictions. Consent or tacit agreement is clear justification for splitting a claim. …

How do I bill telehealth to Medicare for FQHC?

Virtual communication billing codes for RHCs and FQHCs

  1. Use HCPCS code G0071 alone or with other payable services when submitting claims for virtual communication services.
  2. The new payment rate for all claims submitted with code G0071 is $24.76, and covers services delivered on or after March 1, 2020.

What’s new in the 2019 Medicare benefit policy manual?

The 2019 update of the Medicare Benefit Policy Manual, Chapter 13 – Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services provides information on requirements and payment policies for RHCs and FQHCs, as authorized by Section 1861(aa) of the Social Security Act.

What is a rural health clinic?

Rural health clinics (RHCs) are clinics that are located in areas that are designated both by the Bureau of the Census as rural and by the Secretary of DHHS (Department of Health and Human Services) as medically underserved. RHCs have been eligible for participation in the Medicare program since March l, 1978.

Are RHC services covered under Medicare?

Services rendered by approved RHCs to Medicare beneficiaries are covered under Medicare effective with the date of the clinic’s approval for participation. Covered services are described in the Medicare Benefit Policy Manual, chapter 13.