RHC Medicare Billing Resources

Healthcare Business Specialists, LLC is pleased to provide you with these billing resources to help your rural health clinic bill Medicare for your services. Billing RHC services requires the ability to create a UB-04 in an electronic format (837I). Many clinics that are new to RHC billing rely on outside help to bill for services. We have worked with AMS Software out of Raleigh, North Carolina who has been working with RHCs on billing since 1989.  Many RHCs need access to Direct Data Entry (DDE) to verify coverage or adjust claims. Many of our clients use  Ability to connect to Direct Data Entry

Medicare Online Manuals with RHC Billing Guidance:

RHC Billing Guides and Tables from Medicare Administrative Contractors:

Medicare Administrative Contractor Information:

In our last issue of HBS Update on September 11, 2017 we announced that Palmetto GBA has won the contract award for processing of Medicare Part A and Part B claims for Jurisdiction J (Alabama, Georgia, Tennessee) which includes the out of jurisdiction RHCs still processed by Cahaba. Guidance has not yet been forthcoming on the timing of the changeover or what will happen to out of jurisdiction RHCs that have processed by Cahaba since 2009 out of their appropriate jurisdiction. While it seems logical to move these RHCs to their assigned jurisdiction with this changeover, we are not aware of any plans to do so at this time. The timing of the changeover from Cahaba to Palmetto may be delayed for some time if one of the MACs protests the award which is a relatively common event. According to the Fact Sheet on the changeover (see below) questions about the contract award should be directed to Phillip Smith in CMS’ Office of Acquisition and Grants Management.  Telephone (410)786-9492 or email at Phillip.Smith@cms.hhs.gov.

On September 7, 2017, the Centers for Medicare & Medicaid Services (CMS) awarded Palmetto GBA (Palmetto) a new contract for the administration of Medicare Part A and Part B Fee-for-Service (FFS) claims in the states of Alabama, Georgia, and Tennessee (A/B MAC Jurisdiction J). CMS will oversee the transfer of A/B MAC work from the incumbent contractor, Cahaba Government Benefit Administrators, LLC, to Palmetto over the next several months. CMS anticipates that implementation of the new contract will go smoothly, with few, if any, service issues for Medicare beneficiaries and providers. Learn more about this at A/B MAC Jurisdiction J Award Fact Sheet. https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/JurisdictionJAwardFactSheet-09082017.pdf

Source: Contract Award for A/B MAC Jurisdiction J (posted 9/8/2017) https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Whats-New-.html


Chronic Care Management Information:  Below are links to information presented August 1st, 2017 on the new CCM guidelines for RHCs effective January 1, 2018 by CMS: