MRHA Advanced RHC billing 2013

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Transcript MRHA Advanced RHC billing 2013

Mississippi Rural Health
Advanced Billing
for RHCs
By: Joanie Perkins, CPC
Understand what can be
What services qualify for RHC
How to bill hospital services
How to bill preventive services
► How to bill Diabetic Education
► How to bill Mental Health Services
► Claims Submission
► DDE (Direct Data Entry)
99211 Office Visits
► E/M code 99211 is commonly
used for nursing visits,
(injection administration, etc.),
even though physicians
sometimes bill them.
99211 Office Visits
► For RHC purposes, these are
NOT considered encounters.
► They are often reimbursed for
commercial payers.
More on 99211
► If a service is a 99211 and
performed by a nurse, it does
not qualify as an encounter.
More on 99211
If it was performed by a
It could be under-coded
The service does not require
the expertise of a provider (not
medically necessary)
Hospital Services
► Physician services at the
hospital are billed to
Novitas Medicare Part B for
fee-for-service reimbursement.
Hospital Services
► If the parent-entity of the
provider based RHC is a Critical
Access Hospital (CAH) using
option II billing-out-patient
hospital services are billed to the
parent’s FI.
Preventive Services
► Medicare Preventive Services
are partially payable as
Preventive Services
► Welcome to Medicare Physical
► Screening Pay/Pelvic Exam
► Cardiovascular Screening
Welcome to Medicare
► The professional component for
covered preventive services are
payable as an RHC encounter.
Welcome to Medicare
► Diagnostic tests will be billed to
the Part B carrier or Hospital FI.
► Only payable once per lifetime.
Welcome to Medicare
► Deductible and Co-Insurance
do not apply.
► Must be completed within 12
months of Medicare
Other Preventive Services
► The professional component for
the biennial screening pap/pelvic
exam can be billed as an
encounter. The labs will
billed to the carrier or hospital FI.
Other Preventive Services
► All diagnostic tests for the
cardiovascular screening are
billed to the Part B carrier or
Hospital FI.
Other Preventive Services
► Encounters that are normally
non-covered with Medicare part
B are not covered under RHC.
Diabetic and Nutrition
► These are incident to the
physician or mid-level services.
Bundle them into the charge.
Diabetic and Nutrition
► These cannot be billed to the
Medicare Part B carrier and by
themselves do not qualify as an
Diabetic and Nutrition
► The costs for these services are
included in the cost report.
Mental Health Services
► Mental Health Services
performed by a qualified
provider are billed using
revenue code 900.
Mental Health Services
► Diagnostic services are paid as
an encounter.
► Therapeutic services are subject
to a 62.5% payment limitation.
Claim Submission
► Visits with more than one RHC
professional on the same day are
one encounter.
► TriSpan will allow an RHC
encounter and a hospital
admission on the same day.
Claim Submission
► Theoretically, two encounters
on the same day but for
different diagnoses are
Claim Submission
► An RHC encounter and a
mental health visit on the same
day are payable
Revenue Codes
The following revenue codes are
used on UB04 claims:
►0521 clinic visit at RHC by
qualified provider
Revenue Codes
►0522 Home visit by RHC
►0524 Visit by RHC provider to a
Part A SNF bed
Revenue Codes
►0525 Visit by RHC provider to a
SNF, NF or other residential
facility (non-Part A).
Revenue Codes
► 0527 Visiting nurse service in
home health shortage area.
►0528 Visit by RHC provider to
other non-RHC site (scene
of accident)
Direct Data Entry
► Work returned claims
► Access to the Common
Working File for beneficiary
eligibility and benefits.
Direct Data Entry
► Correct and enter claims online.
► Review status of suspended,
pended, and paid claims.
RHC Resources
► NARHC List Serve – just
remember, it’s public and you
can’t discuss setting fees.
RHC Resources
Riverbend LCD
More Resources
► Online
►CMS Rural Health Center
Contact Information
Joanie Perkins, CPC
(662) 756-1703
[email protected]