Local Medical Review Policies

This page links to resources that will assist RHC personnel in billing for RHC services accurately. CMS transitioned from a paper-based manual system for its manual instructions to a Web-based system. The online manuals can be found at the following links.

One of the most important resources for Rural Health Clinics is access to the Local Medical Review Policies of the Medicare Intermediary. Providers and billing personnel should understand these guidelines thoroughly in order to bill RHC services correctly. We have included three resources related to Local Medical Review Policies should be distributed to your providers and billing personnel.

Summary of the Local Medical Review Policies by HBS

On November 19, 2004, CMS issued updated billing instructions for rural health clinics. This 31 page document can be accessed using the following link:

"SUMMARY OF CHANGES: The general billing instructions in chapters 9, 18 and 32 of Pub. 100-04, Medicare Claims Processing Manual are being updated to: (1) provide more detailed instructions overall; (2) eliminate the HCPCS coding for FQHCs; (3) eliminate the additional line item reporting for certain preventive services when billed on TOBs 71x and 73x and (4) except for the telehealth originating site facility fees reported using revenue code 0780, requires all charges to only be reported on the revenue code line for the encounter, 052x or 0900/0910."

Section 410 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173) has amended the law to specify that when a SNF’s Part A resident receives the services of a physician (or another type of practitioner that the law identifies as being excluded from SNF consolidated billing) from an RHC, those services would not become subject to consolidated billing rules merely by virtue of being furnished under the auspices of the RHC.

In effect, the amendment enables RHCs to retain their separate identity as excluded “practitioner” services. As such, these RHC services remain separately billable to the Medicare Part A intermediary (Riverbend, Trailblazer, etc.) when furnished to an SNF resident during a covered Part A stay. The MMA specifies that this provision becomes effective with services furnished on or after January 1, 2005.

To review the Medlearn article on skilled nursing home visits click on the following link:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2004/SE0431.pdf

RHCs must discontinue the use of Revenue Code 910

Historically, CORFs, RHCs, and FQHCs have been required to use revenue code 0910 as the basis for applying the Outpatient Mental Health Treatment Limitation to their claims when billing for psychiatric/psychological services. Likewise, hospital outpatient departments, CMHCs, and CAHs billing under the Outpatient Partial Hospitalization Program have also been required to use this revenue code.

However, the National Uniform Billing Committee (NUBC) has approved the restructuring/renaming of the 090X and 091X revenue code series for psychiatric and psychological services; as part of this restructuring, it has designated revenue code 0910 as “Reserved for National Use.” Thus, the code is unavailable for use. You can no longer use Revenue code 0910 and you must use 0900 in its place effective October 1, 2004. This includes provider-initiated adjustments.

Specifically, RHCs must use revenue code 0900 to report psychiatric/ psychological treatment and services that are subject to the outpatient mental health treatment limitation just as revenue code 0910 was used in the past. The Medlearn article can be found at the following hyperlink:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2004/MM3194.pdf

Clarification of "Incident to" regulations by CMS

In September, 2004 CMS published an article on "incident to" which explains what "incident to" billing is and answers some questions regarding laboratory services, flu shots, and anti-coagulation monitoring.

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2004/SE0441.pdf