Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) face various compliance concerns centered on proper coding and billing. Both are special types of Medicare providers. However, RHCs have recently started using CPT®/HCPCS codes for claims, generating a number of questions surrounding the concept of a visit. For Medicare, RHCs are paid through an All Inclusive Rate (AIR) that is driven by the charges made for a visit. For physician services, CAHs also have a special mechanism for gaining additional reimbursement for outpatient services. This is the Method II billing process. For CAHs that have provider-based clinics or otherwise have physicians providing outpatient services, there is the possibility of gaining increased reimbursement. And with the potential of increased reimbursement there is the concomitant of increased auditing.
The good news: This exclusive webcast addresses both the RHC use of CPT/HCPCS codes and Method II billing for CAHs.
From this session you will...
- Learn the reimbursement process for RHCs.
- Discover what does and does not constitutes a visit.
- Understand the idiosyncrasies surrounding coding and billing for RHCs.
- Realize the difficulties for RHCs in filing claims with CPT/HCPCS codes.
- Learn the compliance issues surrounding proper coding and billing using CPT/HCPCS codes and modifiers.
- Gain an understanding of the reimbursement process for CAHs.
- Review of the features and requirements of Method II billing.
- Learn how to set up your chargemaster to accommodate professional coding and billing.
- Learn the special billing requirements for information that is on the 1500 claim form but not on the UB-04.
CPT® is a registered trademark of the American Medical Association.