Posts by Tamara Niedbalski
Rural Health Clinic CY 2026 All-Inclusive Rate
The Calendar Year 2026 All-Inclusive Rate (AIR) for Rural Health Clinics is $165 per visit, with separate payment rules for hospital-based RHCs and additional payments available for Intensive Outpatient Program (IOP) services. To learn more about these updates, click the link below: 🔗 Medicare Learning Network (MLN) materials
Read MoreRHC Care Coordination Services CMS Claims Adjustment
IMPORTANT UPDATE CMS has identified that some RHC Care Coordination claims were incorrectly paid at geographically adjusted rates. These services should not be geographically adjusted. Medicare Administrative Contractors (MAC) will adjust impacted claims with dates of service on or after January 1, 2025. No provider action is required. If you have questions, please contact your…
Read MoreCLIA Transitioning to a Paperless Process
Beginning March 2026, the Centers for Medicare & Medicaid Services (CMS) will transition the CLIA program to a fully paperless process. Laboratories and providers who perform laboratory testing have until March 1, 2026, to switch to electronic fee coupons and electronic CLIA certificates. After this date, paper fee coupons and paper CLIA certificates will no…
Read MoreRequired Vaccine Billing for RHCs beginning 7.1.2025 Clarified
Sarah Hohman, Director of Government Affairs at NARHC, communicated that written clarification was received from CMS, stating: “The Medicare vaccine billing change (Hepatitis B, Pneumococcal, Influenza, COVID-19) scheduled to begin July 1 is required. Many of us have flagged various documents as using “may” language, but the payment team has now stated it is required.…
Read MoreCMS Releases Updates to Chronic Care Management!
The Centers for Medicare & Medicaid Services (CMS) has published updates to Chronic Care Management! 🔗 Read more: https://www.cms.gov/files/document/chroniccaremanagement.pdf July 2025
Read MoreCare Coordination Services: HCPCS Code G0511 Deadline Extended!
CMS has extended the deadline for billing G0511—allowing more time to make changes to your billing systems. You can continue billing G0511 through September 30, 2025! 🔗 Learn more: https://www.cms.gov/training-education/medicare-learning-network/newsletter/2025-06-05-mlnc#_Toc199925700 6/12/2025
Read MoreMedicare Part B Preventative Vaccine Billing is Changing for Rural Health Clinics!
Starting July 1, 2025, Rural Health Clinics (RHCs) can bill for all four Medicare Part B preventative vaccines and their administration at the time of service! Make sure your billing teams and EHR systems are ready for this change to ensure seamless claims processing starting July 1! 🔗 Helpful Resource:MWHC.net – Medicare Part B Preventative…
Read MoreNondiscrimination Rule Final Deadline Approaching!
🚨 The final deadline to comply is fast approaching! 🚨 All components of the updated Section 1557 Affordable Care Act Nondiscrimination Rule must be in place prior to July 5, 2025. ✔️ Policies and Procedures✔️ Training of existing employees and new hires✔️ Notice of Availability Posting✔️ Notice of Availability must be included in multiple documents, including Consents, EOBs, Discharge Paperwork, Billing documents,…
Read MoreDo You Have Policies in Place to Comply with the Next Deadline Set by the Updated Nondiscrimination Rule?
Effective May 1, 2025, providers must ensure that patient care decision support tools do not yield discriminatory care. Click here to learn more. 4/30/2025
Read MoreMedicare Part B Preventative Vaccines
CMS Releases Guidance on Preventive Vaccine Billing for RHCs! Starting July 1, 2025Rural Health Clinics (RHCs) will be able to bill for all four Medicare Part B preventive vaccines and their administration at the time of service! Covered vaccines include:✔ Pneumococcal✔ Influenza✔ Hepatitis B✔ COVID-19 This is a big step forward in streamlining access and…
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