RHC General Information

10.1 - RHC General Information (Rev. 3434, Issued: 12-31-15, Effective: 03-31-16, Implementation: 03-31-16) RHCs are facilities that provide services that are typically furnished in an outpatient clinic setting. The statutory requirements that RHCs must meet to qualify for the Medicare benefit are in §1861(aa) (2) of the Social Security Act (the Act). A RHC visit is defined as a medically-necessary, face-to-face (one-on-one) medical or mental health visit, or a qualified preventive health visit, with a RHC practitioner during which time one or more RHC services are rendered. A RHC practitioner is a physician, nurse practitioner (NP), physician assistant (PA), certified nurse midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW). A Transitional Care Management (TCM) service can also be a RHC visit. A RHC visit can also be a visit between a home- bound patient and an RN or LPN under certain conditions. RHCs can be either independent or provider-based. Independent RHCs are stand-alone or freestanding clinics and submit claims to a Medicare Administrative Contractor (MAC). They are assigned a CMS Certification Number (CCN) in the range of XX3800- XX3974 or XX8900-XX8999. Provider-based RHCs are an integral and subordinate part of a hospital (including a critical access hospital (CAH), skilled nursing facility (SNF), or a home health agency (HHA)). Information on RHC covered services, visits, payment policies, and other information can be found in Pub. 100-02, Medicare Benefit Policy Manual, chapter 13, http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ bp102c13.pdf. Information on certification requirements can be found in Pub. 100-07, Medicare State Operations Manual, Chapter 2, http://www.cms.gov/Regulations-and-Guidance/ Guidance/ Manuals/ Downloads/ som107c02.pdf.