Can anyone direct me to guidance on how a provider from a rural health clinic bills for the professional service of a surgery in a critical access hospital? Does the CAH bill for it, then pay the physician?
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Resolved Rural Health Clinic Provider Doing Surgery
- Thread starter AmberP_3451
- Start date
A rural health clinic provider billing for professional surgical services performed at a critical access hospital (CAH) typically involves either the CAH billing and paying the physician, or the physician billing independently. The CAH can bill for both facility and professional outpatient services if the physician reassigns their billing rights to the CAH and agrees to the optional payment method. If the physician chooses to bill independently, they would submit their claims under the Medicare Physician Fee Schedule (PFS).
Thank you!
Surgery is not typically billed as an RHC encounter. Instead, it falls under the CAH's outpatient billing procedures. RHCs are designed for primary care services. Surgical procedures, especially those requiring hospital resources, generally fall outside this scope.
Services that qualify as RHC services are billed by the RHC under its own billing procedures, even if the service is provided within the physical location of a CAH. Conversely, services that do not meet the definition of an RHC service should be billed under the CAH's or the individual provider's billing methods.
If you need additional information, I have attached some resources below with the most accurate and up-to-date information on how the professional service of a surgery performed by an RHC provider.
Critical Access Hospitals: Bill Correctly
Noridian Medicare Critical Access Hospitals: Bill Correctly
Services that qualify as RHC services are billed by the RHC under its own billing procedures, even if the service is provided within the physical location of a CAH. Conversely, services that do not meet the definition of an RHC service should be billed under the CAH's or the individual provider's billing methods.
If you need additional information, I have attached some resources below with the most accurate and up-to-date information on how the professional service of a surgery performed by an RHC provider.
Critical Access Hospitals: Bill Correctly
Noridian Medicare Critical Access Hospitals: Bill Correctly
Thank you! This is what I thought. I just wanted to confirm I wasn't crazy.