decisionhealth Newsletters, Answer Books - 2006 Issue 7 (July)
Medicare_Benefit_Policy_Manual / Chapter_13 / 30.3
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Article Overview
This article from the Medicare Benefit Policy Manual addresses services furnished by clinics that are certified as rural health clinics or federally qualified health centers but provide certain services outside those benefit scopes. It is relevant to billing, reimbursement, and cost reporting teams that need to understand the general categories of non-RHC/FQHC services discussed in the manual and how Medicare treats them under other benefit categories.
Why This Topic Matters
It helps providers and billing staff distinguish services that belong in RHC/FQHC cost reporting from services that must be billed and paid separately under other Medicare rules.
Article Sections
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Services Furnished by Clinics Which Are Not RHC or FQHC Services
Overview of clinic services that fall outside the RHC/FQHC benefit scope and the general Medicare treatment of those services. The section also notes related cost-reporting implications.
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The following services are NOT RHC/FQHC services
A categorized list of service types the manual places outside the RHC/FQHC scope, including diagnostic, preventive, equipment, transportation, and prosthetic-related categories.
What You Will Learn
- How the manual distinguishes RHC/FQHC services from services payable under other Medicare benefit categories
- Which broad service categories are identified as outside the RHC/FQHC scope
- How non-RHC/FQHC services are described in relation to billing and cost reporting
- What kinds of service categories are discussed for Medicare payment under separate rules
Who Should Read This
- Medical coders
- Billing staff
- Reimbursement specialists
- Rural health clinic administrators
- Federally qualified health center administrators
- Revenue cycle teams
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