RHC Webinar Series: RHC Eligibility
What is the RHC Certification Process?
Navigating the RHC Certification Journey
Becoming a certified Rural Health Clinic (RHC) is no walk in the park; it’s a rigorous and time-consuming process. Let’s break it down step by step:
- Eligibility Check: First things first, you need to evaluate if your clinic meets the eligibility requirements. This involves looking at factors like your clinic’s location, HPSA or MUA designation, and more.
- Financial Feasibility Analysis: Before diving in, it’s crucial to conduct a financial feasibility study. This helps you figure out if going the RHC route makes sense financially. You’ll examine your patient population, payor mix, and potential costs. If your area has more patients with commercial insurance and fewer with Medicare and Medicaid, converting to RHC status might not be the best move.
- Budget Assessment: Next up, take a close look at the costs involved in converting or upgrading your facility to meet RHC standards. This may include hiring additional staff or making necessary facility improvements to enhance patient access.
- Document Preparation: Gather all the required paperwork, such as IRS documents, incorporation papers, and board member information. Ensure that all your records are accurate and up to date. Any changes, like a new CEO or practice relocation, need to be promptly updated in the CMS PECOS system.
- CMS Application: Once your paperwork is in order, submit your application to the Centers for Medicare and Medicaid Services (CMS) for initial certification. This can be a time-consuming process that demands meticulous attention to detail.
- State Evaluation: After CMS gives the green light, your state will conduct an evaluation to verify compliance with RHC regulations. Be ready for an in-depth, on-site inspection of your clinic’s operations. The duration of this survey varies but can range from four hours to a full two-day assessment, so ensure everything is shipshape.
- Tie-In Notice: When you pass the state evaluation, you’ll receive a tie-in notice (TIN), a pivotal milestone that allows you to bill for RHC services. This is a critical step.
Want to learn more?
There are a lot of steps to becoming an RHC and the certification process. We’re not gonna go into a lot of those today in detail because we do have a webinar coming up to go over that. But, it is a very stringent process. It can be a very time consuming process. It’s not particularly a difficult process. It’s just one that needs to require your full focus to be able to get through that.
The first thing we wanna do is ineligibility about evaluation, meaning, that we need to go out and look to see if we are eligible to have an RHC in our area that as we talked about earlier, do we made a health care shortage area. Are we medically underserved?
Are we in a non urban population of less than 50,000?
So, those type things will go, and we’ll look at those scoreboards when we get into that webinar to see how to read those numbers and percentages so that we can have that information.
You want to do a financial feasibility study.
Does this make sense for you?
Do you have the actual numbers that you need to be able to make this a profitable organization for you financially? Sometimes, it’s not financial to do financially feasible for you to do that, meaning that maybe your census in your area is higher.
And commercial insurance, lower in Medicare and Medicaid. And your contracts are already paying you more than what you would get. So you need to do that feasibility study.
Take a look at that and say you need to be do a comparison study of the cost to convert to an ….
Say you want to see if the cost to update or to fix that facility, to make it meet the regulations required for an RHC.
If that justifies the increase that you would receive in revenue, maybe you don’t have a nurse practitioner in your office and you would need to go out and hire a nurse practitioner. That would certainly be one of the costs.
Maybe there’s some construction costs that need to be done to make it accessible for patients. So, you need to make sure that you convert.
Before you do the actual conversion that you do that study, and you look at that to see, Submitting a package to the CMS have the required paperwork as a tedious process To say the least, you need to go ahead and make sure that you have all your documents.
That you have everything in order, like all of your IRS documents, all of your incorporation, papers.
All of your board members mirrors that you have all that information and that everything is set up with the correct and the same information. Sometimes we move practices.
Sometimes we change CEOs and we fail to go out to things as simple as our NPR website and update that.
Or maybe we don’t have our authorized official, updated within our pecos system for CMS. So, those are all things that you need to look at. And, again, as I said, we’re gonna go into a lot of this process and much more detail when we get to that webinar.
Once you receive back from CMS, an initial recommendation, it will be a letter that will come back to you saying, OK, we have reviewed your application, and we recommend a certification for the RHC. That letter is then filed with this day.
And it goes to the state. And at that point, the state will come in.
They’ll do the actual state survey and the inspection and let us know if they recommend for us to become a rural health clinic that can be a really grueling process, getting ready for the state certification. There’ll be forms that will have to file with your state.
You’ll have to make sure that everything thing is up and clean, that you have things like policy and procedures, that you have infection control, things set up, that your lab work and your … are all set up, that your medical charts have been reviewed, and everything is ready. State server. surveyor will come on, site and spend. I’ve seen some places where they spend as little as 4 to 5 hours. I’ve seen others where they’re on site for two days going through things, so it will vary from state to state, and that process will vary from state to state, just a little bit, not a whole lot.
The basic fundamentals are still there, buddy, it could change a little bit.
Once that survey is done, and you’ve passed the survey, the State will notify CMS that the survey is complete, and, at that time, you’ll receive what’s called a tie.
And notice that tie and notice is very important.
Because, once that comes back, then, were able to file the claims, too, CMS and to Medicaid to be able to get our payment and error rate.
And, as I said, there’s going to be a lot more detail on this. I made this sound really simple. It’s not simple. But it, it, it’s easy to do if you just follow the steps, and we’ll go through that in more detail.