LCD for Rural Health Clinic (L4874)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L4874 

 

LCD Title 

Rural Health Clinic 

 

Contractor's Determination Number 

4874 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2008 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

Title XVIII of the Social Security Act, Section 1862 (a)(1)(A). This section excludes coverage of items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1862 (a)(7). This section prohibits Medicare payment for any expenses on items and services incurred for routine physical examinations.

Title XVIII of the Social Security Act, Section 1833 (e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, section 1861(aa). This section sets forth the rural health clinic services and defines the requirements imposed on RHCs.

CMS Pub 100-2, 13-§30; 30.2; 30.3

CMS Pub 100-4, 9-§10; 40.1; 40.2; 40.4; 210.1
 

 

Primary Geographic Jurisdiction 

Tennessee
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 12/27/2002  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 12/11/2008  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

 

The Least You Need to Know

 

This LCD addresses the medical necessity of the face to face visit in the RHC place of service. Its companion artical addresses statutorily based billing, coding and reimbursement considerations; that article is the definitive reference for RHC coverage interpretations at Riverbend. This LCD provides the medical necssity basis for that article.
Rural Health Clinics provide covered services that can be divided into RHC services and non-RHC services; RHC services are further subdivided into physician services (evaluation and treatment by a physician or physician extender) and services that are "incident to" a physician service.

 

The definition of a face to face encounter is detailed in the accompanying article. Patients that present to the clinic for services that do not require the expertise of a qualified RHC practitioner may receive those services "incident to" a prior physician/extender service (face-to-face visit) but this does not require a new face to face encounter. Even if the provider of the service is a qualified RHC practitioner, the episode still does not constitute a medically necessary visit unless physician/extender services are provided in addition to the "incidental" services. Further, the face to face encounter is not medically necessary because the service does not require a practitioner level of expertise.

 

Thus there are situations in which the provider of the service (e.g. the person giving an injection) may be a qualified practitioner and the service (e.g. the injection) may be medically necessary but it is not medically necessary to have the practitioner re-examine the patient to deliver the service. In these cases it is the physician/extender services that are medically unnecessary; using physician/extenders for services routinely performed by ancillary staff does not create additional reimbursable face-to-face encounters as Medicare is specifically prohibited from reimbursing medically unnecessary services [Section 1862(a )(1) of the Act]. Riverbend is further charged with ensuring that RHC utilization patterns do not diverge from hospital outpatient and physician office patterns, as would be the case here.
Note that the services that do not require physician/extender expertise (and are "incidental" services) are medically necessary incidental services and are reimbursable through the cost report.

 

Many specialty services, such as PT, cardiac rehab, and coumadin clinics, provide primarily non-physician services and therefore generate a high level of costs per face to face visit. These services are not prohibited in the RHC environment, but the RHC may find that excluding them into a non-RHC provider type creates a more appropriate reimbursement model. [Refer to Pub 100-02, chpt 13, Sect 30.3]

This is neither a new limitation on medically necessary services nor a new interpretation of policy; rather it represents a compendium and explication of Riverbend's longstanding interpretation of the various CMS regulations that govern RHC services. Specific billing instructions and documentation requirements are included.





Rural health centers (RHCs) provide primary care services to beneficiaries in rural physician shortage areas. To assist them in that mission, Congress created a special reimbursement mechanism. Independent RHCs are paid a flat rate for each face-to-face encounter based on the anticipated average cost for direct and supporting services, with reconciliation of costs occurring at the end of the fiscal year. This policy applies specifically to independent (free-standing) RHCs but also applies to facility-based institutions except where certain filing instructions are obviously inapplicable due to the different mechanism of reimbursement.


The services provided at a rural health center can be divided into four categories:


1. Face-to-face encounters (or "visits")[Pub 100-04, chpt 9, sect 40.4].

2. RHC services incident to a face-to-face encounter. These services are not directly billed but are reimbursed through the cost report. [Pub 100-04, chpt 9, sect 40.2] Incidental services are typically provided by non practitioners under general physician/extender supervision, although practitioners (particularly therapists who are directly employed by the RHC) frequently also provide incidental services.

3. Non RHC services. RHCs can provide part B covered services that do not fall within their congressional mandate. Examples include physician services to hospital inpatients and physical therapy by contracted therapists. Non RHC services are not reimbursed under the all inclusive rate; rather, they must be billed separately to the appropriate carrier. [Pub 100-04, chpt 9, sect 40.1 and Pub 100-02, chpt 13, sect 30.3]

4. Noncovered services. Noncovered services may be provided and billed directly to RHC patients. However, in no instance can Medicare beneficiaries be billed for services that would be covered under Medicare. [Pub 100.04, chpt 9, sect 210.1]



The correct assignment of charges into these categories is the crucial element of correct Medicare billing and is discussed in the companion article. This policy focusses on the medical necessity element of that determination, specifically the medical necessity of the face to face encounter with a practitioner.

Physician Services

For a face-to-face encounter to be medically necessary, providing evaluation and management services at a skill level that requires the assessment, clinical reasoning, and judgment of a qualified RHC practitioner (i.e. the metaphorical "laying on of hands"). The condition of the patient must warrant the specialized skills of the qualified RHC practitioner. It is expected that either:


1) The patient will initiate the visit with a new problem or an exacerbation of an existing problem that a prudent layperson would believe requires evaluation and/or diagnosis by a qualified RHC practitioner OR

2) The patient has been rescheduled by the practitioner for a follow-up visit under circumstances in which the specified frequency of follow-up is customary, reasonable and necessary.


Medical necessity is required for Medicare services to be reimbursable. This includes a necessity for a physician or physician extender level of care in the case of a face-to-face encounter. Services that do not medically require active physician/extender involvement during any given trip to the facility lack medical necessity for a face-to-face encounter even though the services themselves may well be medically necessary ancillary or incidental services. As a corollary, a visit solely to obtain an ancillary or incidental service does not constitute a medically necessary face-to-face encounter.


In addition to billing constraints described in the companion article, multiple encounters on the same day are not medically necessary except in the unusual instance in which a patient acutely develops a new condition or complication that medically necessitates a second evaluation on that same day [42 CFR 405.2463(a)(3) and Pub 100-04, chpt 9, sect 40.4].

Medical services that do not follow usually accepted standards of current medical practice are not medically necessary. This includes experimental and investigational treatment, unproven applications of existing technology, and diagnostic/treatment plans outside the mainstream of the practice of medicine. In these instances the service is not medically necessary, as is any visit whose primary purpose is to order, render or evaluate the non-covered service.

Incidental ("Incident to") Services




Services that fit the description of incidental services do not establish medical necessity for a face to face encounter. Services that are routinely provided by ancillary personnel such as nurses, therapists, aides, etc.--i.e. incidental services--do not constitute medically necessary face to face encounters even if provided by a physician/extender, unless specific documented medical necessity exists to require a physician/extender level of expertise to render the service. However, medical necessity does exist for periodic physician/extender evaluations to manage the incidental services; only those intermittent evaluation and management encounters should be billed as face to face visits. For the purposes of determining whether a service is customarily a physician service or an incidental/ancillary service, the FI will look at the usual practices of the RHC for non-Medicare patients, the usual practice of other RHCs, and the usual practice of outpatient clinics and traditional physician offices.

Mental Health Services




Clinical Social Worker services in the RHC are medically necessary as a separate face to face encounter only when they replace the services of another practitioner (e.g. physician), not when they merely provide an incidental service in support of a prior physician visit. CSW services are typically medically necessary but not as a separate encounter. Billing of CSW services is primarily a regulatory issue and is discussed in the companion article.


Clinical Psychologist services in the RHC are also medically necessary as a separate face to face encounter only when they replace the services of another practitioner (e.g. physician), not when they merely provide an incidental service in support of a prior physician visit. Psychologist services are typically medically necessary but not as a separate encounter. Billing of Clinical Psychology services is primarily a regulatory issue and is discussed in the companion article.

Therapy Services




When personally performed by a physician/extender, therapy services are valid physician services [42 USC 1395l(g)(1)]. One on one therapy services with a physician/extender may be billed as face to face visits IF it is medically necessary to utilize that level of expertise. For the purposes of determining whether a given service is a physician service or an incidental/ancillary service, the FI will look at the usual practices of the RHC for non-Medicare patients and the usual practice of other RHCs. Further, utilization patterns will be compared with outpatient clinics and traditional physician offices. Face to face therapy encounters that are uncharacteristically shorter or less intensive than their traditional ancillary service counterparts (i.e. typically less than 30 minutes) will be denied as not medically necessary.

Cardiac and Pulmonary rehabilitation (CR/PR) are NOT therapies. Based on utilization patterns in other outpatient environments, up to three physician contacts ("face-to-face visits") will be considered medically appropriate to monitor the course of cardiac or pulmonary rehab. Typically the first CR/PR visit will consist of the new patient comprehensive examination and associated stress test, while the remaining two visits consist of examinations needed to monitor patient progress (and effect routine medication and treatment changes) and/or a post-service evaluation and stress-test. Additional face to face visits only demonstrate medical necessity when precipitated by a sudden deterioration or acute event that necessitates a physician evaluation. A rhythm strip interpretation would be covered (charges bundled) along with the face to face in the setting of a physician evaluation following an acute event, but the routine review of strips generated during CR/PR is typically done after the fact, so additional face to face encounters are not medically necessary. Similarly, routine changes in treatment regimens are usually done based on reported progress, not a face to face exams, so again medically necessary face to face encounters do not occur.


Monitoring and medically supervising rehabilitation is not within the scope of practice of physician extenders. Physician extenders can and do provide the individual services, but the individual services themselves do not require a physician/physician extender level of expertise. Therefore the individual rehabilitation sessions do not represent medically necessary face to face encounters even when rendered by a physician/extender.

Injections




A visit solely to receive an injection does not constitute a medically necessary face-to-face visit if the need for the injection was previously determined. This is true even if a face-to-face contact is made. [CMS Pub 100-4, chpt 12-§200, 100-04, chpt 9, sect 20.1 and 40.4, CMS Pub 100-4, 17-§20]


Allergy shots. A visit solely to receive an allergy shot does not constitute a medically necessary face-to-face visit even if a face-to-face contact is made. The allergy shot is generally administered by ancillary personnel and represents a service that is incident to a prior physician visit. However, if the patient has an adverse reaction that necessitates a physician/extender evaluation (and that examination, assessment and plan is appropriately documented), the encounter may then be appropriately billed as a face-to-face visit.

Methotrexate. Methotrexate in immunomodulating doses does not require a physician visit beyond the frequency necessitated by the underlying disease.

Vitamin B12. The IM administration of B12 may be transiently necessary in any B12 deficiency state but is only medically necessary chronically following a diagnosis of pernicious anemia or chronic iatrogenic low stomach acid state. However, even when appropriately administered, a face to face encounter is not medically necessary with each injection. In the setting of newly diagnosed B12 deficiency with symptoms, patient evaluations may be required weekly times four and then monthly times twelve. In the absence of symptoms attributable to B12 deficiency, two or three visits within the first six months may be necessary for patient education and re-evaluation . Following this initial period, annual visits may be necessary (whether or not the patient is continuing injections) if the patient is not being otherwise seen for chronic problems. More frequent physician/extender encounters are not medically necessary due to the slow rate of relapse following B12 repletion.

Flu shots and vaccinations (influenza, hepatitis B and pneumonia vaccines) do not necessitate a face to face visit.

Other injections (such as epogen) also usually represent incidental services when the need for the injection is previously established, even if the physician/extender specifies a change in dosage. This is because the physician/extender is merely responding to a lab test; a re-evaluation of the patient is not indicated with each adjustment. Conversely, a face to face encounter is medically necessary when it is the accepted standard of practice in physician offices and outpatient clinics, generally because a clinical re-evaluation of the patient is also indicated (e.g. 24 hours after an initial dose of IM antibiotics but not routinely after each subsequent dose).

Dressing changes



There may be instances when a caretaker is unable to adequately perform dressing changes or where the level of complexity of the care requires the skills of a nurse. These dressing changes do not constitute medically necessary face to face visits solely because the service was provided by a physician/extender if similar services could be provided by nurses or other designated office staff. Except in the special case of visiting nurse services, medical necessity for a face to face encounter is based on:


1) The need for a physician/extender to monitor the underlying wound at a frequency that does not differ from the usual patterns of utilization in an office or outpatient clinic OR

2) An exacerbation or complication that would trigger an examination in those environments OR

3) Sharp debridement requiring the skills of a physician/extender.

 

Lab tests




An encounter expressly for the purpose of obtaining blood for lab tests does not constitute a medically necessary face-to-face visit even if a face-to-face contact with the provider is made. To be considered as a face-to-face visit, there must be some additional medically necessary evaluation or management component.


The process of reporting a lab result to the patient, even if a medication is changed as a result, is also usually incidental to the initial visit. A visit for the purpose of reporting the lab result is only medically necessary (in the absence of a separately indicated evaluation) when the information being reported to the patient is of sufficient complexity or gravity to demand an additional extended physician/extender discussion with the patient. Examples of this would include (but are not limited to) a complex metabolic profile with multiple abnormalities, an evaluation for cancer, and a finding of a new disease (e.g. diabetes). The periodic monitoring of a given test (e.g. INR, CBC, etc.) should not be associated with routine follow-up visits to report the results as this does not reflect the practice in physician offices and outpatient clinics. The routine use of a visit to discuss lab results is not medically necessary.

Prescription Services




Writing or refilling prescriptions and services such as intermittently dispensing medications (oral or injectable) to psychiatric patients or drug abusers and counting/filling pill dispensers for disabled or demented beneficiaries do not require a face to face evaluations in the typical outpatient setting. Thus the need for a prescription refill or medication disbursement will not contribute to establishing medical necessity for the face to face encounter. These are covered services, but are incidental to the underlying physician/extender examination and treatment.


Pain management is a covered RHC service but the enabling of a drug addiction (either within or outside of a drug rehabilitation program) is not. Frequent medication refills for narcotics do not represent medically necessary face to face encounters, but they nonetheless indicate a potential quality of care issue and the overall pain management strategy should be well documented in the chart. Visits for the injection of narcotics usually require an evaluation and thus a face to face visit, but they should also be part of a well documented pain management strategy that includes diagnostic investigations and/or pain specialty consultations that attempt to minimize addiction and maximize patient well being. A pattern of over-utilization of the RHC for multiple patients in the absence of pain management strategies is not medically necessary and additionally may be an indicator of more serious problems.

Paperwork




The paperwork involved in maintaining records, documenting encounters for third parties and completing forms for patients is an incidental part of medical practice. These services (when provided in support of an activity not otherwise excluded from coverage, such as disability examinations) are reimbursed by Medicare through the cost report as services incidental to the covered encounter. A period of time spent solely in record keeping cannot be considered as a face to face visit. An actual face to face encounter solely for the purpose of creating or filling out paperwork is not a medically necessary visit; the visit must be justified by a medically necessary evaluation or treatment.

Visit for Non-covered Service




Face to face encounters primarily to receive services that are not considered to be medically necessary (such as alternative medicine interventions) are themselves not medically necessary.

Routine Services



Routine physician/extender examination, vision exams and examinations for hearing aids are not Medicare covered services but are additionally considered to be not medically necessary. The routine physical checkup exclusion applies to all examinations performed without a relationship to the treatment or diagnosis of a specific illness, symptom, complaint, or injury; it also applies to examinations required by third parties (such as employment or insurance evaluations). Eye examinations are not covered for the purpose of prescribing, fitting or changing eyeglasses (e.g. refractions). Eye examinations are only covered in conjunction with a medically necessary evaluation to diagnose or treat an eye disease, and hearing exams must be directed to uncovering a specific pathology.[Pub 100-02, chpt 16, sect 90] Routine foot care is not covered except in the setting of a systemic disease that requires care to be performed by a skilled practitioner in order to avoid the risk of injury to the patient.[Pub 100-02, chpt 15, sect 290]


Unless specifically covered by statute, primary preventive services are not covered and are additionally not considered to be medically necessary for the diagnosis or treatment of disease. Screening tests are not medically necessary for diagnosis when used for screening; they are only considered medically necessary when used in the diagnosis or exclusion of suspected disease. Preventive services therefore include medical social services, most nutritional assessments, preventive health education, prenatal and postpartum care, routine physicals (including well child care), immunizations, eye and ear screening, family planning, routine screening procedures (urine dipstick, stool guaiac, serum cholesterol, weight and BP), risk assessment (including undirected history taking and physical exam to ascertain risks), and thyroid screening, among others.


Certain screening and/or preventive services such as mammography have a special benefit delineated by Congress. If a face-to-face visit is medically necessary, it is covered and may be billed on that basis. However the visit is only medically necessary if the practitioner personally performed the service and the service is not typically performed by a non-practitioner. Bone mass measurement therefore does not typically support medical necessity for a visit unless the practitioner is need to perform the exam itself. Stool guaiac for cancer screening would similarly not support a face to face (unless the digital rectal exam benefit was being provided).

 
Although Diabetes self management (DSM) must be certified as medically necessary by a physician/extender, the actual educational intervention is usually provided by other professionals, typically nurses. A face-to-face service beyond that which occurred when the intervention was ordered (certified) is not medically necessary.

Recurrent Services




1. Blood Pressure Measurement: Follow-up visits to monitor blood pressure which include physician/extender evaluation and management services are appropriately identified as encounters. The documentation should reflect the performance of these services over and above the simple measurement of a blood pressure. The frequency of follow-up is medically necessary when consistent with the recommendations of The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. [http://www.nhlbi.nih.gov/guidelines/hypertension/jncintro.htm] Specific medical necessity must be clearly documented to support frequencies greater than:


New diagnosis (first 6 months); lifestyle modification: monthly (q 30 days)

New diagnosis (first 6 months); pharmacological management: monthly (q 30 days)

Established diagnosis; lifestyle modification; controlled: quarterly (q 90 days)

Established diagnosis; pharmacological management; uncontrolled: monthly as long as at least every other visit supports active intervention (change in therapy)

Established diagnosis; pharmacological management; controlled: quarterly (q 90 days)

Accelerated or unstable hypertension with a need for rapid control of pressure: medically necessary as long as each visit supports ongoing direct and active intervention (change in therapy) during the period of frequent follow-up.


Visits solely to obtain BP measurements are incidental to the primary E&M visit, and any follow-up at a frequency that is not supported by current standards of care is not medically necessary.


2. Disease Management Clinics: Disease Management clinics do not represent a special Medicare benefit category. Visits to clinics of this type are subject to the same requirements for medical necessity as all other face-to-face encounters: namely, there must be a requirement for a physician/extender level evaluation, re-evaluation or therapeutic intervention at each visit. Routine visits, i.e. visits at a frequency greater than that which is supported by current standards of care in physician offices and outpatient departments, are not medically necessary and are not covered.


3. Lab Follow-up Clinics: Visits to lipid clinics, prothrombin (Coumadin) clinics and other lab-based follow-up clinics generally do not demonstrate a need for physician/extender face-to-face discussion of results other than in the two or three visits following diagnosis. Exceptions are expected to demonstrate a well-documented and unique need for the face to face interaction. The routine use of a visit to discuss lab results is clearly not medically necessary; medical necessity for this is discussed above.


4. Specially Clinics: Diabetes clinic visits are medically necessary when medical complications of the disease are addressed, or when monitored at a frequency consistent with recommended standards of care. Routine Foot Care clinics are always not medically necessary except in the setting of diabetes with loss of protective sensation [Pub 100-04, chpt 32, sect 80]. Pain Management clinic visits demonstrate medical necessity for a given frequency of visits when supported by the immediate pain management needs at the time of each visit and by the documentation of progress with respect to the overall pain management strategy.


5. Chiropractic clinics: Coverage of chiropractic services is determined primarily by regulations, discussed in the companion article.

Off-site Services



A physician/extender visit to a beneficiary in a skilled SNF bed or a swing bed is medically necessary on a monthly basis to evaluate the patient status as it relates to the skilled service. A physician/extender visit may constitute a medically necessary face-to-face more often than monthly only if the medical record supports the necessity of more frequent evaluation. (For the purposes of medical review, monthly shall mean no less than 21 days between visits.)

A physician/extender visit to a beneficiary in a non-skilled bed, intermediate care facility or nursing home is not medically necessary on a routine basis even if the nursing facility requires it as a condition of patient residence. However, Medicare does "presume" visits to be medically necessary if they are used to satisfy Federal Regulations. Based on these requirements, detailed in the Code of Federal Regulations [42 CFR 483.40], a visit to a patient in a non-skilled bed, ICF or nursing home will be considered medically necessary if it has been approximately 60 days (for the purposes of medical review at least six weeks) since the last visit. At frequencies greater than this the encounter is only medically necessary if it occurs in response to a patient complaint or in follow-up to an established medical condition; in both instances the visit is medically necessary only if an office visit would be medically necessary under the same circumstances.

Visiting Nurse Services



A physician/extender home visit to perform services typically rendered by home health or visiting nurses is only covered as a distinct benefit when the criteria for VNS are met. When VNS criteria are not met, the home visit is subject to the same medical necessity requirements as an office-based face to face encounter, and a physician/extender home visit solely to perform home health services will be denied as not medically necessary for a physician level of expertise.

Home Visit



Medical necessity for the home visit is identical to medical necessity for office visit -- i.e. the fact that the patient is homebound does not confer any additional necessity for a physician/extender level of care. A home visit is not medically necessary if an office visit would not be medically necessary for the same patient condition.
 

 

Coverage Topic 

Doctor Office Visits
 

 

Coding Information

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

 

 

Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

0521

Free-standing clinic-rural health clinic

0522

Free-standing clinic-rural health home

0524

Visit by RHC/FQHC practitioner to a member in a covered Part A stay at the SNF

0525

Visit by RHC/FQHC practitioner to a member in a SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility

0527

RHC/FQHC Visiting Nurse Service(s) to a member’s home when in a home health shortage area

0528

Visit by RHC/FQHC practitioner to other non RHC/FQHC site (e.g., scene of accident)

0900

Psychiatric/psychological treatments-general classification

 

 

CPT/HCPCS Codes 

 

XX000

Not Applicable

 

 

ICD-9 Codes that Support Medical Necessity 

 

XX000

Not Applicable

 

 

Diagnoses that Support Medical Necessity 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

 

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

The Code of Federal Regulations sets forth minimum requirements for RHC records; the documentation requirements for the RHC thus have both a medical necessity component and a direct regulatory requirement. RHC medical records must include:


1. Reports of physical examinations, diagnostic and laboratory test results, and consultative findings;

2. All physician's orders, reports of treatments and medications, and other pertinent information necessary to monitor the patient's progress;

3. Identification and Signatures of the physician or other health care professional. [42 CFR 491.10(a)(3)(iv)]




Each page of the medical record must be assignable to a specific patient by some form of identification, either a complete patient name or a unique medical record number. This represents Riverbend's interpretation of 42 CFR 491.10(a)(3)(i). It may additionally be considered a contractor-specific documentation requirement as well as good medical practice. Documents lacking this identification will not provide evidence of the performance of a specific service or of its medical necessity unless accompanied by a signed affirmation from the provider of that service. The affirmation must state that the provider personally remembers providing that service to the specific beneficiary in question on that date documented. The medical records must contain enough sufficiently unique information to support the ability to affirm that relationship after whatever time has transpired between the service and the affirmation.


Each face to face encounter documented in the medical record must include the date on which the encounter occurred or, in the case of multiple visits on a single day, the date and time of the visits.This represents Riverbend's interpretation of the Social Security Act Section 1833(e), which charges the FI with obtaining the necessary records to ensure that services are billed and reimbursed as provided. It may additionally be considered a contractor-specific documentation requirement as well as good medical practice. Documents lacking a date will not provide evidence of the performance of a specific service or of its medical necessity unless accompanied by a signed affirmation from the provider who rendered the face to face. That affirmation must state that the provider personally remembers providing the service to the beneficiary on the specified date. The medical records must contain sufficient information to plausibly support an ability to remember that relationship between the service and the date after whatever time has transpired between the service and the affirmation. An affirmation signed more than sixty days after the service was rendered will not usually validate a memory of a specific date.


Each face to face encounter documented in the medical record must end with the signature of the provider who personally performed the face to face visit. This represents Riverbend's interpretation of 42 CFR 491.10(a)(3)(iv). It may additionally be considered a contractor-specific documentation requirement as well as good medical practice. Documents lacking this signature will not provide evidence of the performance of a specific service or of its medical necessity unless accompanied by a signed affirmation written by the provider who rendered the face to face visit. The affirmation must state that the provider personally remembers performing the face to face with the specified beneficiary on the date in question. The medical records must contain sufficiently unique information to support the ability to affirm that provider relationship after whatever time has transpired between the service and the affirmation . An affirmation signed more than sixty days after the service was rendered will not usually validate a memory of a specific service, unless the documentation clearly shows a level of expertise that only the actual provider (out of all the personnel at that facility) would possess.


In the above instances, the term affirmation refers to a simple signed and dated notation by the provider attesting that he can vouch for the validity of the record despite its documentary deficiency. No particular legal forms or securities are required or expected.  


The provider signature may be appended to the medical record in any of several formats, but in all cases must be sufficiently unique to allow both the provider and Riverbend to determine unequivocally at a later date that the provider personally affixed the signature. The signature should ideally be legible but must at the minimum be ideographic (a consistently reproducible and unique autograph). A full name (e.g. John Smith) or a last name and credentials (e.g. Smith MD) are necessary for the signature to stand alone. If the signature serves to authenticate a typed, stamped, dictated, computer-generated signature or third-party signature, it must still be sufficiently unique to unequivocally identify the author. Printed initials are inadequate for that purpose; a last name or script initials is usually the minimum appropriate validation. If credentials are not appended to the signature, the credentials associated with the signature must be apparent elsewhere in the documentation:


1. Handwritten entry by the provider with provider signature. Since the entry itself is ideographic, the signature need only include enough legible information to identify the provider. A last name is generally sufficient. If the facility wishes to keep a "signature registry" of its providers (a page with signatures and typed or printed entries identifying the owners of the autographs), it can provide a copy of the appropriate entry with any requested records in order to allow the decoding of illegible ideographs.

2. Handwritten entry by staff with provider signature. The signature must conclusively identify the provider, and the entry itself must make it clear that the provider (rather than the staff member) performed the face to face.

3. Dictated entry.A dictated (typed) signature must be countersigned (an ideographic validation as detailed above) by the provider who performed the face to face, confirming that the provider has reviewed the dictation and verified that it was correct.

4. Stamped signature. A stamped signature is acceptable as long as the facility has implemented procedures which clearly establish ownership and control over access to the stamp. The physicians/extenders must be able to affirm that the stamp is available to them alone and that sufficient controls exist such that the stamped signature can be identified as being personally affixed by the provider and therefore equivalent to an inked autograph. A single affirmation for each physician/extender, which may be combined with a signature registry, should be kept on file at the facility. A copy should be provided if medical records with stamped signatures are requested; it is not necessary to create a new document for each record request. No specific format is required, however a template is provided for convenience at the end of this policy.

5. Computer generated typed signature. Computer generated paper records are analogous to dictations. The typed signature must be countersigned by the provider who performed the face to face, confirming that provider has reviewed the computer generated record and verified that it was correct.

6. Electronic signature on electronic records. Purely electronic records are those that are stored electronically and printed only when documentation is needed by a third party such as Riverbend. These records must be accompanied by a copy of an affirmation from the provider that entries are password protected and ONLY the provider has access to the password. A single affirmation by each physician/extender may be kept by the office and copied for submission with any record requests; it is unnecessary and unduly burdensome for providers to create a unique affirmation for each record request.



The intention of these regulations is to make sure that the physician/extender's documentation is clearly attributable to that individual and to ensure that services are clearly documented in such a way that it is obvious who was providing the service and to what extent. For example, some offices allow nurses to administer injections and also initial documents with the provider's initials. If these situations occurred together, it could create a misrepresentation of a face to face encounter that had never occurred.


If medical records are requested for review, the provider should furnish:


1. The record for the requested date of service and, to define the therapeutic milieu in which the service is being rendered, the notes for the two preceding visits. If more than two visits occurred in the 30-day period immediately preceding the date of service, all additional notes for that period should be included.

2. Visits for recurring services and follow-ups should include a copy of the notes for the visit that established the need for the follow-up service.

3. The inclusion of a provider phone number may facilitate an accurate review and provider feedback.

4. Identification of each signatory by title if titles were not included in their signatures.

5. Copy of affirmation of password protection for electronic records, affirmation of control of signature stamp, or signature registry, if applicable.


 

 

Appendices 

Verification of Signature

FACILITY NAME: ____________________________________________________________

Electronic Signatures: If this facility uses electronic signatures, system controls exist such that ONLY the provider has access to the password that allows the system to affix the "signature" that identifies that provider as the author of the record. This facility [ ] DOES [ ] DOES NOT use electronic signatures.

Stamped Signatures: If any providers at this facility use signatures stamps, sufficient controls exist at all times such that ONLY the provider has access to the stamp. The use of the stamp will therefore clearly identify the provider as the author of the record. This facility [ ] DOES [ ] DOES NOT allow use of stamped signatures.

Signed: _____________ Facility Administrator
Date:________________

The following signatures identify the providers indicated and additionally signify their affirmation of the above statements.

Use Signature Stamp TYPED(PRINTED)NAME SIGNATURE DATE

1.[ ]Yes [ ]No __________________________________________
2.[ ]Yes [ ]No __________________________________________
3.[ ]Yes [ ]No __________________________________________
4.[ ]Yes [ ]No __________________________________________
5.[ ]Yes [ ]No __________________________________________
6.[ ]Yes [ ]No __________________________________________
7.[ ]Yes [ ]No __________________________________________
8.[ ]Yes [ ]No __________________________________________
9.[ ]Yes [ ]No __________________________________________
10.[ ]Yes [ ]No _________________________________________
 

 

Utilization Guidelines 

1. The Fiscal Intermediary is required to compare RHC and outpatient hospital utilization for the same services to identify any significant differences in utilization patterns, and also to compare RHC claims with carrier claims for similar services in physician offices. Riverbend also looks at norms for type and frequency of service by beneficiary for specific diagnoses in RHC and non-RHC (outpatient) places of service. [Pub 100-08, chpt 2, sect 2.2.4.1]

2. Claims will not be globally denied based on utilization patterns. However, individual services will be reviewed and face to face encounters will be denied as not medically necessary if the frequency of visits is not consistent with norms in other outpatient venues, unless the documentation in the medical records clearly supports the need for the excessive utilization. Similarly, the intensity of service during face to face encounters will also be reviewed and visits will be denied as not medically necessary if an abnormal number of brief low-intensity visits are performed relative to other outpatient norms. Services that are split across several visits will have all except the initial visit denied if they are usually performed at a single visit in other outpatient environments.

3. Potentially excessive utilization patterns will be evaluated along two lines, based on the distinction between scheduled (provider initiated return) and unscheduled (patient initiated return) visits:


a. Scheduled return visits are not medically necessary when the RHC practitioner schedules routine monitoring or follow-up at a frequency that significantly exceeds usual standards of practice and for which the medical record does not show clinical necessity.

b. Unscheduled return visits are not medically necessary when the patient exhibits a pattern of presenting without a problem or an exacerbation of an existing problem that would cause a prudent layperson to seek medical evaluation and treatment. This pattern of behavior constitutes an excessive utilization problem for the RHC primarily when the facility a) does not attempt to educate the patient about the appropriate use of medical resources, b) enables multiple patients to overuse resources or c) maintains a fee structure that inappropriately encourages casual utilization.


 

 

Sources of Information and Basis for Decision 

CIM 35-14
CIM 35-25
CIM 50-8.1
42 FR 405.2401
42 FR 405.2463 (a); 42 FR 405.2463 (a)(2); 42 FR 405.2463 (a)(3); 42 FR 405.2463 (a)(4)
42 FR 410.60 (e)(2)(iv)
42 FR 483.40
42 FR 491.9 (c)(2)
42 FR 491.10 (a)(3)(i); 42 FR 491.10 (a)(3)(iv)
MCM 14 -3-15050.c; MCM 14-5202
CMS Pub 100-4, 18 §§10-10.1.3, 10.2-10.24, 10.3, 10.3.2-10.3.2.3
CMS Pub 100-2,13 §30; 100-2, 13 §30.3; 100-2, 13 §30.2
CMS Pub 100-4, 9 §10
PIM 83-2-2.4.3.1; PIM 83-2-2.4.3.1.A
PM A-00-30
PM AB-01-69
RGBA LMRP 079-01 converted LCD L4874
RHC 27-123
RHC 27-321
RHC 27-401 & 402; RHC 27-404.1; RHC 27-405.1, 401.2, 401.3; RHC 27-406, 406.1, 406.3, 406.6
RHC 27- 412.1; RHC 27-419.1, 419.2
RHC 27-437; RHC 27-438.c
RHC 27-500, 500.A; RHC 27-501.1; RHC 27-502; RHC 27-504
RHC 27-614; RHC 27-640
SSA section 1833 (e)
42 USC 1395 f (d)(3); 42 USC 1395 I (g)(7)

Wintrobe's Clinical Hematology, 10th Edition. Lippincott, 1999.

"The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure", NIH National Heart, Lung and Blood Institute. 1997

Medi 2051-05
 

 

Advisory Committee Meeting Notes 

Public Open Meeting to discuss the draft policy was held 07/09/2002.


This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from general medicine, internal medicine and family practice as well as RHC providers. 

 

Start Date of Comment Period 

06/05/2002 

 

End Date of Comment Period 

07/20/2002 

 

Start Date of Notice Period 

11/13/2002 

 

Revision History Number 

L4874d 

 

Revision History Explanation 

08/31/2005 Language stating "RHC and FQHC services remain separately billable to the FI when furnished to an SNF resident during a covered Part A stay" added to Indications and Limitations of Coverage and/or Medical Necessity.

08/09/2004 Crosswalked references to Online Manual

03/11/2003 Filled in "Coverage Topic" selection

This LCD was converted from an LMRP on 12/28/2005

7/2/2006 - The description for Revenue code 0521 was changed
7/2/2006 - The description for Revenue code 0522 was changed

7/2/2006 - Revenue code 0524 was added to the code range 0520 - 0529
7/2/2006 - Revenue code 0525 was added to the code range 0520 - 0529
7/2/2006 - Revenue code 0527 was added to the code range 0520 - 0529
7/2/2006 - Revenue code 0528 was added to the code range 0520 - 0529

06/29/2007 - Revenue code correction

11/16/2007 - Typographical correction made to references in CMS Internet Only Manuals (IOM)

08/27/2008 – The state of New Jersey removed from the Primary Geographic Jurisdiction as required by the MAC-PartA/PartB contractor workload number 12401

08/27/2008 – Frequently Asked Questions removed from Appendices as the link could not be restored

12/11/2008 - B12 Injection paragraph change: The IM administration of B12 may be transiently necessary in any B12 deficiency state but is only medically necessary chronically following a diagnosis of pernicious anemia or chronic iatrogenic low stomach acid state. 

 

Reason for Change 

Narrative Change
 

Last Reviewed On Date 

12/11/2008 

 

Related Documents 

Article(s)
A38185 - Rural Health Clinic

 

LCD Attachments 

FAQ - Comment and Response (86,460 bytes)