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| 10/30/2020 @ 2:25:00 PM
Post 1 of 7
Contributor: Mike Galluzzi, Allegheny Health Center RHC
are therapy services provided by a Licensed Clinical Social Worker (LCSW) a covered RHC visit when delivered in a nursing home?
10/30/2020 @ 2:55:00 PM
Post 2 of 7
Contributor: Madora Albertson, Weiser Memorial Hospital Family Medical Center
This is a great question and I would also like to know! ---------- Original Comments ---------- Last Post By: Mike Galluzzi, Penn Highlands Healthcare are therapy services provided by a Licensed Clinical Social Worker (LCSW) a covered RHC visit when delivered in a nursing home? 10/30/2020 @ 3:48:00 PM
Post 3 of 7
11/2/2020 @ 10:00:00 AM
Post 4 of 7
Contributor: Jackie King, ArchProCoding
Good morning,
First check that your LCSW meets the definition of an RHC provider per the Medicare Benefit Policy Manual, Chapter 13 If that is a yes, then refer to the same manual 40.1 - Location RHC or FQHC visits may take place in: * the RHC or FQHC, * the patient's residence (including an assisted living facility), * a Medicare-covered Part A SNF (see Pub. 100-04, Medicare Claims Processing Manual, chapter 6, section 20.1.1), or * the scene of an accident. RHC and FQHC visits may not take place in: * an inpatient or outpatient department of a hospital, including a CAH, or * a facility which has specific requirements that preclude RHC or FQHC visits (e.g., a Medicare comprehensive outpatient rehabilitation facility, a hospice facility, etc.) See Medicare Claims Processing Manual, Chapter 6 Effective January 1, 2005, section 410 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) amended the SNF consolidated billing law to specify that when a SNF's Part A resident receives the services of a physician (or another type of practitioner that the law identifies as being excluded from SNF consolidated billing) from a RHC or a FQHC, those services are not subject to CB merely by virtue of being furnished under the auspices of the RHC or FQHC. Accordingly, under section 410 of the MMA, services otherwise included within the scope of RHC and FQHC services that are also described in clause (ii) of section 1888(e)(2)(A) are excluded from consolidated billing, effective with services furnished on or after January 1, 2005. Only this subset of RHC/FQHC services may be covered and paid separately when furnished to SNF residents during a covered Part A stay (see the regulations at 42 CFR 411.15(p)(2)(xvii) and 405.2411(b)(2)). Use TOBs 71x and 73x, respectively, to bill for these RHC/FQHC services. Also see the Medicare Claims Processing Manual, Chapter 9 * 0524 Visit by RHC/FQHC practitioner to a member in a Code Description covered Part A stay at the SNF (skilled admission) * 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 Hope this helps, Jackie [cid:image001.png@01D579EB.4BFCECC0] Jackie King, MSHI, CPC, COC, CRHCP, RH-CBS Director of Compliance & Clinical Informatics, HIM Consultant Illinois Critical Access Hospital Network (ICAHN) | 1945 Van's Way, Princeton, IL 61356 P 815.875.2999 | F 815.875.2990 | jking@icahn.org 11/30/2020 @ 5:12:00 PM
Post 5 of 7
Contributor: Jeannie Harkness, Banner Medical Group
What if the nursing home is an entity within a CAH. Specifically, it is attached to the hospital.
11/30/2020 @ 5:16:00 PM
Post 6 of 7
Contributor: Jeannie Harkness, Banner Medical Group
What if the nursing home is an entity within a CAH. Specifically, it is attached to the hospital.
Jeannie Harkness Clinic Manager, Boundary Community Clinic Office: (208) 267-3655 Fax: (208) 267-3757 Be the change you wish to see. -Ghandi 12/1/2020 @ 11:22:00 AM
Post 7 of 7
Contributor: Joanie Perkins, Sunflower Rural Health Clinic
I believe this article will be helpful Jeannie. Location of the facility isn't the question, it is the provider and type of service, and in my opinion, are payable RHC services according to CMS guidelines whether the NH is located within the footprint of a CAH, or any other type of facility.
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