Rural Healthcare Billing

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.

  1. From Admin on the Left Side Menu, select System Settings.

  1. Select Charges from the menu.
  2. Scroll down to UB04_Used.
  3. 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.

  1. Select the Add button.

  1. Use the Lookup Icon to choose the Insurance.
  2. Add a Description, such as, MEDICARE RHC.
  1. Professional CPTs®: Add CPT® codes that should be submitted as an 837P/CMS1500. These are generally Labs and X-rays.
  2. 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.
  3. 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.
  4. 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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