On December 31, 2015, CMS updated Chapter 9 of the Medicare Claims Processing Manual and Chapter 13 of the Medicare Benefit Policy Manual addressing payment and certification of Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). 

CMS updated the Benefit Policy Manual to include new information, clarify existing policies, and make editorial changes.  Specifically, the changes alter the RHC staffing requirements set forth in Section 30.1.  Under the revised Section 30.1, a RHC can count the time of a nurse practitioner (NP), physician assistant (PA), or certified nurse midwife (CNM) when furnishing direct patient care in a patient’s home or another location towards the requirement that an NP, PA, or CNM be available to furnish care at least 50 percent of the time the RHC is open to provide patient care.

The revised Chapter 13 also authorizes RHCs and FQHCs to receive reimbursement for chronic care management services and sets forth the requirements for reimbursement, as described in a new Section 110.5.  The revised Chapter 13 also provides that lung cancer screening using low-dose computer topography is a covered service and may be billed as a stand-alone visit if (1) it is the only service furnished on that day with a RHC or FQHC practitioner and (2) applicable coinsurance and deductibles are waived. 
The Claims Processing Manual has been reorganized and updated to include more comprehensive billing information, but there are no new policies contained in the updated Chapter 9. 

The official instructions regarding the Chapter 9 and Chapter 13 changes and the revised Chapters are available here and here, respectively.

Reporter, Kristin Roshelli, Houston, TX, + 1 713 751 3263, kroshelli@kslaw.com.