What Are The Benefits Of RHC Certification?
- Enhanced Medicare reimbursement – 25-75% increase in revenue²
- Cost-based reimbursement
- Visit fee is the same for physicians and mid-level providers
- Visit fee is the same regardless of E&M level
- Bad Medicare debt can be recouped
- Simplified Medicare billing procedures
- Exempt from MACRA, however it may still be beneficial to submit
Enhanced Medicare reimbursement is the driving force behind a clinic seeking RHC certification.
The U.S. Health Resources & Services Administration (HRSA) has stated that a clinic with a minimum 50% Medicare or Medicaid patient volume will see anywhere from a 25% to 75% increase in revenue.
A typical medical practice is reimbursed based on Medicare’s Fee-For-Service (FFS) schedule.
RHC reimbursement is based on a flat fee per visit with a cost-based reconciliation done at the end of the year.
For independent and large hospital-owned RHCs, the flat fee per visit is capped. In 2019, Medicare set the RHC Cap rate for the per visit reimbursement at $84.70. RHCs owned by small hospitals are not subject to the per visit reimbursement cap.
The end of the year cost report allows RHCs to be reimbursed for:
- Bad Medicare patient debt (at 65%),
- Some vaccine costs,
- lab costs, and
- the technical part of diagnostic test costs.
It is important to note that it may not be beneficial for all clinics to obtain RHC status as it depends on the clinic’s payor mix. Evaluating the financial feasibility of RHC status is critical in determining if your clinic should proceed with RHC certification.
Beyond reimbursement, RHCs may experience other benefits such as operational efficiency utilizing mid-level providers and may be able to qualify for other federal or state programs.
Can Being An RHC Lower Physician Burnout?
A rural phenomenon, results from a pilot study released in 2018 suggest that practicing in rural areas may actually decrease physician burnout. This is good news as rural areas are already susceptible to physician shortages. In addition to being rurally located, RHCs can stay ahead of burnout with four tips found in How to Overcome Physician Burnout in 2019.