Revenue Cycle

CMS announces RHC and FQHC payment rate increases for 2012

Medicare Update for CAHs, January 11, 2012

In early November, CMS issued a transmittal that provides the payment rate increases for rural health clinics (RHCs) and federally qualified health centers (FQHCs), which are effective January 1, 2012. These changes specifically update chapter 9, section 20 of the Medicare Claims Processing Manual.

The RHC upper payment limit per visit increased from $78.07 to $79.48 effective January 1, 2012 through the calendar year. This increase reflects a 1.8% increase over the 2011 limit in according with the rate of increase in the Medicare Economic Index as authorized by §1833(f) of the Social Security Act, according to the CMS transmittal.

For urban FQHCs, the upper payment limit per visit also increased by 1.8%; from $126.22 to $128.49. The maximum Medicare payment limit per visit for rural FQHCs went from $109.24 to $111.21. Both of these increases are effective for calendar year 2012, according to CMS.

Though the effective date on the transmittal is January 1, 2012, a January 3, 2012 implementation date is necessary in order to update RHC and FQHC payment rates in accordance with §1833(f) of the Social Security Act. Contractors—to avoid administrative burdens—shall not retroactively adjust individual RHC/FQHC bills paid at previous upper payment limits. However, the contractor has the ability to make adjustments to the interim payment rate or a lump sum adjustment to total payments already made to take into account any excess or deficiency in payments to date, according to CMS.

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