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).

 

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.


Hidden Setting

Ask your Implementation Manager or Support to add the Hidden Setting for RHC Billing.


  • Default > Ruralhealth > Y


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 Set up 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.

  3. Professional CPTs: Add CPT codes that should be submitted as an 837P/CMS1500. These are generally Labs and X-rays.

  4. 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.

  5. 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.

  6. Select Save [F2].

 


Additional Hidden Settings

Ask your Implementation Manager or Support to add the Hidden Settings if needed.

  • To Default Admit and Discharge Dates
  • Section: UB
  • Code:  DISSTAT
  • Value:  01
  • Default Type of Bill
  • Section: UB
  • Code:  TOB
  • Value:  711 or other value specific to Practice.

Add Cross Codes

Ask your Implementation Manager or Support to add these Cross Codes.


  • Change CFI for UBs (Changes the Claim Filing Indicator)
  • Code Group:  ANSI
  • Code:  CFII
  • Cross Code:  MA
  • Roll-up Code (All codes sum to first line (E&M), and other lines change to a penny.)
  • Code Group:  CHARGES
  • Code:  UPDATETOONEPENNY
  • Cross code:  Y



CPT® copyright 2019 American Medical Association. All rights reserved.

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