Riverbend

Rural Health Clinic FAQ

What revenue code is used for a Rural Health Clinic visit in an assisted living or residential home setting?

Per the RHC Local Coverage Decision  (L4874), you would use revenue code 0522 or 0527. Revenue code 0522 is defined as "Free-standing clinic-rural health home", while revenue code 0527 is stated as "RHC/FQHC Visiting Nurse Service(s) to a member’s home when in a home health shortage area". (03/11/2008)

If a claim processes for timely filing, can the patient be billed for the coinsurance amount?

Yes. The IOM 100-04, CH 1 General Billing Requirements, Section 70.4 Determination of Untimely Filing and Resulting Action states “Where the beneficiary request for payment was filed timely (or would have been filed the request timely had the provider taken action to obtain a request from the patient whom the provider knew or had reason to believe might be a beneficiary) but the provider is responsible for not filing a timely claim, the provider may not charge the beneficiary for the services except for such deductible and/or coinsurance amounts as would have been appropriate if Medicare payment had been made.” (03/11/2008)