Sequestration Beginning in 2013, Sequester mandated 2% cut in Medicare payments was adopted. This applied to all providers. As of April 1, 2013, Medicare RHC payments were reduced from 80% of the approved amount to 78.4% of the approved amount. II. Legislative Update 26
20.1 - RHC Location Requirements (Rev. 173, Issued: 11-22-13, Effective: 01-01-14, Implementation: 01-06-14) A clinic applying to become a Medicare-certified RHC must meet both the rural and underserved location requirements. Mobile clinics must have a fixed schedule that specifies the date and location for services, and each location must meet the location requirements. Existing RHCs are not currently required to continue to meet the location requirements. RHCs that plan to relocate or expand should contact their Regional Office to determine their location requirements. III. RHC Policy Manual 32
IV. RHC Billing 37 What Is Different About RHC Billing? RHC services are billed and reimbursed by Medicare (and Medicaid in some states) under an all-inclusive payment rate regardless of the type of practitioner (physician vs. midlevel) or the complexity of services performed (99212 vs. 99215, E/M vs. surgical procedure). RHC services are billed to Medicare on the UB-04 claim format instead of the CMS 1500 form often used for billing physician services. CPT/HCPCS codes are typically not reported for Medicare RHC billing purposes (except for preventive services).