RHC Financial Resources

Rural Health Clinic Financial Assistance Program 

Billing and Coding

Washington Medicaid (Apple Health) 

Billing Guide 

The Billing Guide for RHCs on the state Health Care Authority (HCA) site offers concise billing instructions for RHCs, covering coding and eligibility in Washington State.  

Encounter Rates 

This fee schedule on HCA's site details Medicaid encounter-based reimbursement rates for RHCs, helping clinics understand payment for qualifying visits.  

Enhancement Rates 

This fee schedule on HCA's site explains additional reimbursement options for RHCs that support expanded care in rural areas.  

Medicare

Physician Fee Schedules

Medicare Part B pays for physician services based on the Medicare Physician Fee Schedule (MPFS) on the Noridian Healthcare Solutions website, which lists the more than 7,400 unique covered services and their payment rates. Physicians' services include office visits, surgical procedures, anesthesia services, and a range of other diagnostic and therapeutic services.

Medicare RHC Billing Guide

This billing guide for RHCs on Noridian's website offers instructions on billing Medicare and Medicaid, detailing allowable services, coding, documentation standards, and reimbursement processes for accurate claims submission. (Site requires you click Accept in their pop up User License Agreement and Consent to Monitoring window to access the RHC Billing Guide.)

Medicare Claims Processing Manual Chapter 9 – Rural Health Clinics/Federally Qualified Health Centers  

This claims processing manual (PDF) provides in-depth information on billing and claims submission for RHCs. This chapter helps clinics understand the claims process, including guidelines for coding, payment, and compliance with Medicare billing requirements.  

RHC Upper Payment Limits (UPL) Guidance   

This guidance provides essential information (PDF) for healthcare providers, including RHCs, on the maximum allowable payment rates that states can reimburse providers under Medicaid. 

Cost Reporting

Cost Reporting for Rural Health Clinics (Chapters 29 & 46)

The Provider Reimbursement Manual Part 2 on Centers for Medicare & Medicaid Services (CMS) website is a key resource for Rural Health Clinics navigating Medicare cost reporting and reimbursement.

Rural Health Clinic CG Modifier Reporting Requirements

Rural Health Clinics are required to report an HCPCS code for each service furnished along with an appropriate revenue code. This resource provides information and common questions (PDF) about how RHCs should follow the reporting requirements for modifier CG.