What is a Rural Health Clinic?

A Rural Health Clinic is a clinic located in a non-urbanized area and is certified to receive special Medicare and Medicaid reimbursement. The purpose of the RHC program is improving access to primary care in underserved rural areas. RHCs are required to use a team approach of physicians and midlevel practitioners such as nurse practitioners, physician assistants, and certified nurse midwives to provide services. The clinic must be staffed at least 50% of the time with a mid level practitioner. RHCs can be public, nonprofit, or for-profit healthcare facilities.

In most states, there are two types of RHCs:

Independent Rural Health clinics

Independent RHCs are free-standing clinics owned by a provider or a provider entity. They may be owned and/or operated by a larger healthcare system, but do not qualify for, or have not sought, provider-based status. More than half of independent RHCs are owned by clinicians.

Provider-Based Rural Health ClinicS

Provider-based RHCs are owned and operated as an essential part of a hospital, nursing home, or home health agency participating in the Medicare program. RHCs operate under the licensure, governance, and professional supervision of that organization. Most provider-based RHCs are hospital-owned.

COMPONENTS

  • RHCs receive special Medicare and Medicaid reimbursement rates that are all inclusive to the patient visits. These rates are initially determined by environmental factors and healthcare accessibility.

  • RHCs are required to undergo full inspection surveys by an accrediting organization that federally certifies the clinic as a RHC. Some states require that the facility obtain licensure by their state’s Department of Health in order to participate in the Medicaid RHC Program.

  • RHCs must have a mid-level provider employed and available to patients at a minimum of 50% of the facility’s operating hours.

  • RHCs are required to submit a cost report annually to CMS and Medicaid to determine the all inclusive rate.

  • RHCs are required to obtain specific contracts with Medicare and Medicaid Managed Care Organizations (MCO). This ensures that the payers will reimburse the facility at the determined rates.

  • It is an RHC requirement to contract or employ a Medical Director to provide oversight of the facility and services.

  • Federal regulations mandate that RHCs be located in rural areas, medically underserved areas (MUA) and/or HPSA provider shortage areas.

  • Although RHCs are reimbursed at an all inclusive rate regardless of the services that are provided, proper documentation and coding are required. Particular fee schedules and billing procedures must be implemented for successful RHC reimbursement.

  • It is required that RHCs develop and enforce specific policies and procedures that adhere to state and federal regulations.

  • RHCs are required to complete Emergency Preparedness Operations Training.

Designated RHC Locations

RHCs are located in non-urbanized areas, and to receive certification, they must be located in rural, underserved areas that has been shown to have a shortage of healthcare services or health care providers.

photo taken of: Heinin Medical Clinic in Kinder, LA

Benefits of RHCs in Rural Communities

- Complete access to primary care that would otherwise be limited or non-existent

- Resources to ancillary healthcare

- Combats physician shortages by using mid-level providers

photo taken of: Heinin Medical Clinic in Kinder, LA

Benefits of RHC Certification

- Enhanced Medicare rate – 25-75% increase in revenue

- Cost-based reimbursement

- Visit reimbursement is the same for physicians and mid-level providers

- Exempt from MACRA, however it may still be beneficial to submit

- All inclusive rates regardless of Evaluation and Management level

-Medicare debt can be recovered

- Simplified Medicare and Medicaid billing procedures