How are federally certified Rural Health Clinics reimbursed for the healthcare services they provide?
The greatest benefit of the program is cost-based (enhanced) reimbursement from Medicare and Medicaid. RHCs are paid on the basis of an encounter which is defined as a medically necessary, face-to-face visit between the patient and a physician, physician assistant, nurse practitioner, nurse midwife, specialized nurse practitioner, visiting nurse, clinic psychologist or clinical social worker during which an RHC service is rendered. RHCs are reimbursed the lower of the national capped amount or the clinic-specific cost per encounter. The national capped amount is indexed for inflation and can increase each year. RHC payment is subject to the Part B cash deductible. This amount is subject to regulatory change. After the deductible has been satisfied, RHCs are reimbursed 80 percent of the all-inclusive reimbursement rate. The patient is responsible for a coinsurance amount equal to 20 percent of the billed amount. For newly certified RHCs, the reimbursement rate will be automatically esta
Related Questions
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