mississippi rural health association
DESCRIPTION
Mississippi Rural Health Association. Advanced Billing for RHCs By: Joanie Perkins, CPC. Objectives. ►Understand what can be bundled ►What services qualify for RHC ►How to bill hospital services ►How to bill preventive services. Objectives. ► How to bill Diabetic Education - PowerPoint PPT PresentationTRANSCRIPT
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Mississippi Rural Health Association
Advanced Billing for RHCs
By: Joanie Perkins, CPC
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Objectives► Understand what can be bundled
► What services qualify for RHC
► How to bill hospital services
► How to bill preventive services
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Objectives► How to bill Diabetic Education
► How to bill Mental Health Services
► Claims Submission
► DDE (Direct Data Entry)
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99211 Office Visits► E/M code 99211 is commonly used for nursing visits, (injection administration, etc.), even though physicians sometimes bill them.
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99211 Office Visits► For RHC purposes, these are NOT considered encounters.
► They are often reimbursed for commercial payers.
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More on 99211► If a service is a 99211 and
performed by a nurse, it does not qualify as an encounter.
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More on 99211► If it was performed by a provider:
a. It could be under-coded
b. The service does not require the expertise of a provider (not medically necessary)
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Hospital Services► Physician services at the
hospital are billed to Novitas Medicare Part B for
fee-for-service reimbursement.
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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.
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Preventive Services
► Medicare Preventive Services are partially payable as encounters.
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Preventive ServicesInclude
► Welcome to Medicare Physical
► Screening Pay/Pelvic Exam
► Cardiovascular Screening
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Welcome to Medicare Physical
► The professional component for covered preventive services are payable as an RHC encounter.
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Welcome to Medicare Physical
► Diagnostic tests will be billed to the Part B carrier or Hospital FI.
► Only payable once per lifetime.
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Welcome to Medicare Physical
► Deductible and Co-Insurance do not apply.
► Must be completed within 12 months of Medicare entitlement.
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Other Preventive Services
► The professional component for the biennial screening pap/pelvic exam can be billed as an encounter. The labs will be billed to the carrier or hospital FI.
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Other Preventive Services
► All diagnostic tests for the cardiovascular screening
are billed to the Part B carrier or Hospital FI.
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Other Preventive Services
► Encounters that are normally non-covered with Medicare part B are not covered under RHC.
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Diabetic and Nutrition Counseling
► These are incident to the physician or mid-level
services. Bundle them into the charge.
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Diabetic and Nutrition Counseling
► These cannot be billed to the Medicare Part B carrier and by themselves do not qualify as an encounter.
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Diabetic and Nutrition Counseling
► The costs for these services are included in the cost report.
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Mental Health Services
► Mental Health Services performed by a qualified provider are billed using revenue code 900.
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Mental Health Services► Diagnostic services are paid as an encounter.
► Therapeutic services are subject to a 62.5%
payment limitation.
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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.
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Claim Submission► Theoretically, two encounters on the same day but for different diagnoses are payable.
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Claim Submission
► An RHC encounter and a mental health visit on the
same day are payable
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Revenue CodesThe following revenue codes are
used on UB04 claims:
►0521 clinic visit at RHC by qualified provider
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Revenue Codes►0522 Home visit by RHC
provider
►0524 Visit by RHC provider to a Part A SNF bed
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Revenue Codes
►0525 Visit by RHC provider to a SNF, NF or other residentialfacility (non-Part A).
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Revenue Codes
► 0527 Visiting nurse service in home health shortage
area.
►0528 Visit by RHC provider to other non-RHC site
(scene of accident)
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DDEDirect Data Entry
► Work returned claims electronically.
► Access to the Common Working File for beneficiary
eligibility and benefits.
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DDEDirect Data Entry
► Correct and enter claims online.
► Review status of suspended, pended, and paid claims.
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RHC Resources
► NARHC List Serve – just remember, it’s public and
you can’t discuss setting fees.
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RHC Resources► Riverbend
www.rgbagov.com
► Riverbend LCDhttp://www.rgbagov.com/
publications/lcd/lcd-files/4874.html*
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More Resources►Main Site
www.cms.hhs.gov
► Online Manuals www.cms.hhs.gov/Manuals/IOM/list.asp?listpage=1
►CMS Rural Health Centerwww.cms.hhs.gov/center/rural.asp
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Contact InformationJoanie Perkins, CPC(662) [email protected]