CAHs and RHCs: Compliant Coding and Billing

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Start Time:12:00 AM
End Time:12:00 AM
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Provided by MHA Center for Education

Date & Time

Thursday, March 16, 2017
10 - 11:30 a.m.

Register on or before Monday, March 13, to ensure delivery of instructional materials.

MHA members — $225
Nonmembers — $275

The registration fee is for one connection. One webinar registration/connection allows for an unlimited number of participants. Dial-in information is for one physical location, so encourage staff to join you!

This webinar is being offered at a reduced registration fee to MHA-member hospitals because of a contribution from MHA Management Services Corporation.


RHC and CAH coding staff, billing and claims transaction staff, nursing staff, outpatient service area staff, chargemaster coordinators, financial analysts, compliance staff, physicians, revenue cycle specialist, practitioners

The following program content was provided by the speaker.


Rural health clinics and critical access hospitals are both special types of Medicare providers. RHCs recently have started using CPT/HCPCS codes for their claims, which, has generated a number of questions surrounding the concept of a visit. For Medicare, RHCs are paid through an all-inclusive rate that is driven by the charges made for a visit.

CAHs also have a special mechanism for gaining additional reimbursement for outpatient physician services, known as the Method II billing process. For CAHs that have provider-based clinics or otherwise have physicians providing outpatient services, there is the possibility of gaining increased reimbursement. Of course, for both RHCs and CAHs, there are a host of compliance concerns surrounding proper coding and billing. This workshop addresses both the RHC use of CPT/HCPCS codes and Method II billing for CAHs.


  • review the reimbursement process for RHCs
  • discuss what does and does not constitutes a visit
  • review some of the idiosyncrasies surrounding coding and billing for RHCs
  • express the difficulties for RHCs in filing claims with CPT/HCPCS codes
  • discuss compliance issues surrounding proper coding and billing using CPT/HCPCS codes and modifiers
  • review the reimbursement process for CAHs
  • review the features and requirements of Method II billing
  • explain the special coding and billing requirements for physicians using the Medicare physician fee schedule
  • review how to set up the chargemaster to accommodate professional coding and billing
  • discuss special billing requirements for information that is on the 1500 claim form but not on the UB-04
  • discuss additional compliance requirements for Method II billing for CAHs


  • Overview
    • RHCs
    • CAHs
    • cost-based reimbursement
    • Method II billing for CAHs
  • Rural Health Clinics
    • special characteristics and requirements
    • provider-based vs. independent
    • cost-based reimbursement through the AIR
    • definition of a visit
  • RHCs - coding and billing requirements
    • use of CPT/HCPCS codes
    • use of modifiers
    • UB-04 claim formatting
    • compliance issues
  • CAHs
    • special characteristics and requirements
    • provider-based clinics and physician outpatient services
    • Method I versus Method II billing for physician services
    • MPFS
  • CAH - Method II billing and reimbursement
    • coding and billing process
    • claims filing professional on UB-04
    • chargemaster concerns
    • physician reassignment – CMS-855-R
    • compliance concerns
  • Additional Concerns
    • telemedicine
    • rural healthcare designations
    • case studies
  • Sources for Further Information


Duane C. Abbey
Abbey & Abbey Consultants, Inc.
Ames, Iowa

Duane Abbey is a management consultant and president of Abbey & Abbey Consultants, Inc., based in Ames, Iowa. For more than 20 years, Abbey & Abbey Consultants, Inc., has provided health care consulting services to hospitals, hospital systems, physicians, medical clinics and integrated delivery systems. In addition to consulting, Abbey has been an invited presenter for hospital associations, medical societies and other groups. He also has published articles and books on health care topics. Abbey earned his graduate degrees from the University of Notre Dame, in South Bend, Indiana, and Iowa State University, in Ames.