Required Billing Updates for RHCs – Eff. April 1, 2016

From: CMS Transmittal 1596; 1/26/16

Transmittal Excerpt:

New Policy:

Effective for dates of service on or after April 1, 2016, RHCs, including RHCs exempt from electronic reporting under §424.32(d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code, and other codes as required.

Payment for RHC services will continue to be made under the all-inclusive rate (AIR) when all of the program requirements are met. There is no change in the AIR system and payment methodology including the “carve out” methodology for coinsurance calculation due to this reporting requirement.

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