Provider-Based Rural Health Clinics (RHCs) Ask-the-Contractor Teleconference (ACT) Minutes
April 16, 2009
Chairperson: Elizabeth A. Uraga
The Central Region ACT, "Provider-Based Rural Health Clinics (RHCs)" teleconference was called to order by Elizabeth A. Uraga, Medicare Outreach Analyst - Omaha Office, at 1:00 PM Central Time.
Elizabeth began the teleconference by introducing herself. She was joined by other Outreach Analysts and members of the Provider Outreach & Education staff, as well as Customer Service. Introductions were followed by a brief description of the purpose of the call.
The introductory discussion was followed by the presentation on RHCs, which included information on RHC payment, RHC billing, and RHC services.
Following the presentation, providers were encouraged to stay abreast of Medicare news and WPS educational events through WPS eNews. To sign up, go to http://www.wpsmedicare.com and enter your e-mail address in the yellow box in the top right corner.
At the conclusion of the presentation, the line was opened up for questions from the audience.
OPEN QUESTION AND ANSWER SESSION:
Q1. Are dental services ever covered? What about an emergency extraction?
A1. Dental services are not covered. Exceptions to this policy are described in the Centers for Medicare & Medicaid Services (CMS) Benefit Policy Manual (100-02), Chapter 16, Section 140.
Q2. Where can I find information on what drugs are covered under Part B and how to code those drugs? Although we don't bill the (Healthcare Common Procedure Coding System) HCPCS codes as a certified RHC, formerly we billed our drug charges under a 25X revenue code as non-covered. We have since been told that some drugs we provide may be covered. For example, a patient left our clinic for the ER only to receive a prescription. The ER had no claim for Medicare, so we put the drugs on our claim.
A2. The RHC should not bill for drugs provided by another facility. The ER must determine whether the services provided by the ER constitute a visit and bill accordingly.
Q3. The HCPCS/Current Procedural Terminology (CPT) code for pulmonary function (94010 and 94640) contains both the technical and professional components. In other words, there are not separate codes: one for the technical component and one for the professional component. We provide the professional component only. How do we calculate what charges should go on our claim under just the professional component?
A3. On the RHC claim, bill the professional component under the 52X revenue code. Do not report the HCPCS/CPT code. The RHC charge should reflect the standard charge for professional services. The base provider bills the technical component on its claim under the appropriate revenue code.
Q4. What is a technical component as compared to a professional component of a given service?
A4. The technical component of a service is that portion of a service not performed by the doctor/professional. For example, when a patient receives an x-ray, the technical component would be the materials, the use of the equipment, the use of the facility, etc. The professional component would be the doctor reading the x-ray.
Q5. If a patient comes for an injection alone and not a visit, how should we bill that injection or other service that doesn't constitute an RHC visit?
A5. The CMS Claims Processing Manual (100-04), Chapter 9, Section 100(B) states "For services that do not qualify as a billable visit, the usual charges for the services are added to those of the appropriate (generally previous) visit....Use the date of the visit as the single date on the line item."
This concluded the question and answer portion of the call.
References included in this presentation are for informational purposes only. Current Medicare regulations will prevail.
There were 266 participants on 105 lines for the teleconference.
Page Last Updated: Tuesday, 29-Dec-2009 13:39:26 CST
