Practice Management Alert

Question: An acquaintance coder I know from networking online just started working at a rural health clinic and is having a really tough time. I didn’t think there was that much of a difference between clinics in towns or cities and ones in more rural areas. What’s going on?

Minnesota Subscriber

Answer: Your acquaintance may work at a Centers for Medicare & Medicaid Services (CMS)-certified rural health clinic (RHC), which is a public, nonprofit, or for-profit healthcare facility in a rural, underserved area, staffed at least 50 percent of the time by a nurse practitioner (NP), physician’s assistant (PA), or certified nurse midwife (CNM).

RHCs receive “enhanced” Medicare and Medicaid reimbursement rates for the outpatient primary care and basic laboratory services they provide. A Medicare Learning Network fact sheet explains that the rate is an “all-inclusive rate (AIR) for medically necessary primary health services and qualified preventive health services furnished by an RHC practitioner.”