Updated: 3/2/2006

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Riverbend Government Benefits Administrator Links

News

This Page is linked to Riverbend Government Benefits Administrator in Chattanooga, Tennessee.  It contains useful reimbursement and cost reporting information for rural health clinics.

Calculations of coinsurance and/or payments associated with Rural Health Clinic claims  
We earlier reported that FISS updates in October had resulted in incorrect calculations of coinsurance and/or payments associated with Rural Health Clinic claims. This was a national issue that impacted all FISS RHC Intermediaries. The FISS system was corrected on October 25, 2004. Riverbend GBA will initiate adjustments of all impacted claims to correct the coinsurance and payment amounts. Because many of the claims impacted were hardcopy, we must let the 27 day payment floor expire before the adjustment process can begin. As a result, the adjustments will be initiated beginning the week of November 29, 2004. Due to the volume of claims involved, the adjustments will be performed over a several days.

Credit Balance Report Status 
Check the status of your credit balance report on-line. An 'X' in both the received and accepted column means all was acceptable with your report. An 'X' in the received column but not the accepted column indicates that some information was missing from your report. If your report has been received and not accepted we will be contacting you to inform you as to what corrections are needed.

 

HIPAA Conferences  
The Centers for Medicare & Medicaid Services is conducting a series of one-day HIPAA Conferences. The purpose of these conferences is to reach out to the local health care organizations and providers to deliver valuable and practical information, tools and resources regarding the HIPAA Simplification regulations. The title is " Implementing the Next Wave of HIPAA Regulations".

Cost Reporting Information

Pneumococcal & Influenza Injection Reimbursement For Rural Health Clinics

Reimbursement is on a cost per injection basis. No claims are filed for these injections. Reimbursement is made only on the cost report. A log of all injections given to Medicare beneficiaries must be submitted with the cost report to receive any reimbursement. Log should include the following:

  • Patient name
  • HIC number
  • Date injection given
  • Calculating the ratio of injection staff time to total health care staff time (Worksheet B-1 line 2; compute separate ratios for pneumococcal and flu)

Example:

Time to give an injection  - 10 minutes
Total injections given  - 300
Total health care staff hours - ( 2,080 hrs. x 3 FTE’s) 6240

10 min. / 60 min. = .16667
x total injections - 300
Total injection time - 50 hrs.
divided by total H/C
staff hours - 6240
Ratio = .0080

Riverbend Contacts For Rural Health Clinic Providers

Claims or coverage issues - Claims Counselor (423) 755-4586
Credit Balance Reports - Cheryl Cambron (423) 755-5853
Withhold on Pmts/Penalties - Tracye Ward (423) 763-7087
Cost Reports - RHC Technicians see below

Technician - States - Phone Number
Katherine Walker - MN, ND, SD, WI, SC, MS -| (423) 763-3682
Tina Marie Jackson - AR, OH, TN, KY, NC - (423) 763-3678
Diane Reed - NE, ID, WA, KS, MI - (423) 763-3813
Sarah Johnson - AL, AZ, GA, CA - (423) 763-3808
Sally Roberts - AK, FL, IL, PA - (423) 763-3809
Rebecca Porter - IA, IN, MO, OR - (423) 763-3199

Medicare Cost Report Information

  • Cost report is due 5 months after the close of the period covered.
  • Terminating cost reports are due 150 days after the termination of provider agreement.
  • Extension to file the cost report may be granted by intermediary only for extraordinary circumstances such as a natural disaster or fire or flood.
  • Intermediary furnishes the Provider Summary Report (PS&R) no later than the last day of the fourth month or 120 days following the end of the provider’s fiscal year. This will be sent to the providers by certified mail.
  • Interest accrues on deemed overpayments until provider files the cost report.
  • Riverbend Government Benefits Administrator has cost report software available free of charge to aid providers in completing their cost reports.

General RHC Cost Reporting Tips

  • Collect as much data as possible on an ongoing basis.
  • Set up accounting procedures to collect as much financial data in the form and level of detail required for year end reporting. Use the cost report forms for reference.
  • Determine early if the clinic will need to collect special data for the cost report.(i.e. related party expense)
  • Check the cost report for mathematical accuracy.
  • Be consistent from year to year.
  • Complete the entire cost report.
  • Use the PS&R report provided by the intermediary to report Medicare visits, deductibles and payments.
  • Use correct and current forms.
  • Send adequa te documentation to support information on the cost report.
    • Injection logs
    • Bad debt logs
    • Working Trial Balance
    • CMS 339 Questionnaire
    • Workpapers to explain reclasses on W/S A-1 and adjustments on W/S A-2
  • Review the cost report for reasonableness. (i.e. $300 cost per pneumococcal injection is not reasonable)

Cost Report Software

Click on a link to open the file, or to begin the download procedure. (If you have trouble initiating the download by clicking on the link, then right-click the link and choose Save Target As, Save File, Save Link As, etc.) The software must be decompressed, since it currently in zipped format.

Cost Report Software (4MB zip file)
Instructions (15K PDF file)

RHC Payment Limit For 2004

The cost per visit is subject to a maximum amount established by CMS. CMS published the 2004 upper payment limits in Change Request 3075 . The maximum rates are as follows:

Year

Rate

2004

$ 68.65

2003
 (3/1/03 -12/31/03)

$66.72

2003
 (1/1/03 – 2/28/03)

$66.46

2002

$64.78

2001

$63.14

2000

$61.85

1999

$60.40

1998

$59.04

Laboratory Carve-outs

Laboratory Carve Out Example
Laboratory Carve Out Example

 

 

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