Local Medical Review Policies
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 that should be distributed to your providers and billing personnel.
Skilled Nursing Home Visits
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.