Source: http://northamericanhms.com/author/northamericanhms/page/2/
Timestamp: 2019-04-24 13:52:43+00:00

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February 10, 2015 By Charles James Jr.
The following Rural Health Clinic Survey and Certification Letter was released updating some CMS guidance relative to staffing.
• Definitions, §491.2 The definition of a “physician” has been revised to include a doctor of dental surgery or dental medicine, a doctor of podiatry or surgical chiropody, or a chiropractor, within the limitations of services these types of physicians are permitted to offer under Section 1861(r) of the Social Security Act. However, it continues to be the case that only MDs or DOs may fulfill the requirements for supervision, collaboration and oversight of non-physician practitioners in an RHC or FQHC.
• Staffing and Staff Responsibilities, §491.8 §491.8(a)(3) was revised to permit an RHC to have a nurse practitioner or physician assistant provide services under contract to the RHC. This increased flexibility does not eliminate the longstanding statutory and regulatory requirement that the RHC must have at least one employee who is a nurse practitioner or physician assistant. This change was effective July 1, 2014. §491.8(a)(6) was revised to require for RHCs that a nurse practitioner, physician assistant, or certified nurse-midwife is available to furnish patient care services at least 50% of the time the RHC operates.
This aligns the regulatory language with the current statutory requirement. Note that since the statutory provision was self-implementing, CMS has enforced the 50% standard even prior to this regulation change. (See S&C 09-14) §491.8(b) has been revised to delete the requirement formerly at §491.8(b)(2) for a physician to be present in the RHC or FQHC at least once every two weeks. This recognizes that many of the physician’s required functions may be performed remotely via electronic means, but does not remove the requirement that a practitioner, whether a physician or non-physician practitioner, must be present at all times the RHC or FQHC operates. Provisions formerly at §491.8(b)(1)(i) – (iii) have been renumbered to be §491.8(b)(1) – (3), but are otherwise the same.
February 9, 2015 By Charles James Jr.
In the office, among other criteria, incident-to services must be rendered by a qualified provider who is directly supervised. To meet supervision requirements for incident-to, the billing provider does not have to be physically present in the treatment room while the service is being provided, but must be present in the immediate office suite, for the entire duration of the service, to render assistance if needed.
If the billing physician is a solo practitioner, he/she must directly supervise the care. In a group practice, there may be situations when the provider responsible for the treatment plan is not the provider physically present in the office suite when the patient is seen in follow up. Thus, the supervising provider can be different than the ordering provider.
January 28, 2015 By Charles James Jr.
Many Rural Health Clinics were surprised by the PQRS Penalty Letters which were received in late 2014 have generated significant confusion. We, as Rural Health Clinics, were under the impression that RHCs are exempt from PQRS and the associated penalties.
This IS indeed, the case. Rural Health Clinics are exempt from PQRS penalties. The problem is a technical one. The PQRS penalty is based on fee-for-service, CMS-1500 claim submissions. These claims are paid based on individual, Medicare Part B provider numbers associated with Medicare Part B, non-RHC, group numbers.
CMS does not have a way to associate these non-Rural Health Clinic provider numbers with Medicare Part A, RHC PTAN numbers.
Keep in mind: the penalty is NOT assessed against Rural Health Clinic Part A payments. The penalty is only levied on non-RHC services such as hospital, lab, and x-ray. Your own exposure to these non-Rural Health Clinic penalties should be limited.
For the time being, these penalties will continue to be assessed on your non-Rural Health Clinic provider numbers.
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