Rural Healthcare Billing
Rural Healthcare (RHC) and FQHC Billing
The RHC and FQHC set up allows split billing (X-rays & Labs on 837P and all other services on 837I) by CPT® code, and single Encounter claims that roll up to a specific CPT® code (example: T1015 or T1040). You have the ability to send both claims to the same Payer by using a cross code to change the CFI (Medicare Part A and Medicare Part B).
Ask your Implementation Manager or Support to add the Internal Settings for RHC Billing.
RHC & FQHC Setup
Activate UB04 (Institutional) Claims
This will give the option to choose Insurance Form Type, and adds a Charge Entry Dropdown to choose Professional or Institutional.
- From Admin on the Left Side Menu, select System Settings.
- Select Charges from the menu.
- Scroll down to UB04_Used.
- Select Yes.
Access the New RHC Screen
- From Admin on the Left Side Menu, select the Rural Health Setup button.
Add an RHC Profile
For all Payers that require an Encounter to split between 837I/UB04 and 837P/1500, an RHC Profile must be set up. Access the Rural Health Setup screen to add the Profiles.
- Select the Add button.
- Use the Lookup Icon to choose the Insurance.
- Add a Description, such as, MEDICARE RHC.
- Professional CPTs®: Add CPT® codes that should be submitted as an 837P/CMS1500. These are generally Labs and X-rays.
- Sick Visit CPTs®: Enter the Sick Visit CPTs® that should be sent as 837I/UB04. The first line on the 837I/UB04 will have Revenue Code 052X with the total Charge Amount.
- Wellness Visit CPTs®: Enter the Preventive Visit CPTs®. The Preventive Visit goes on a second line with Revenue Code 052X and the fee for the Preventive Service only.
- Select Save [F2].
Split Encounters
Splitting Encounters allows you to separate specified Procedure lines from one Encounter to a new Encounter.
- This feature is available when entering or modifying a Charge and from the Encounter Dashboard.
- This is very useful for a split of UB/Institutional Procedures and Professional Procedures (ANSI/HCFA), Rural Healthcare (RHC), or Durable Medical Equipment (DME).
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