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| Cost
Report Preparation |
| RHA
will coordinate with the clinic's accountant, business manager and
other staff to obtain information to complete the annual Medicare
and Medicaid (where applicable) cost reports. RHA will advise the
clinic and verify adjustments submitted by the Fiscal Intermediary
to make tentative and final settlement to the cost report. If the
clinic is audited, RHA will provide assistance until the audit is
completed. |
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| RHA
will provide a mini cost report on those clinics that are at risk
of a lower cost per visit rate based on the cost cap. This report
will be prepared quarterly. |
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| Fiscal
Intermediary Field Audits |
| RHA
will provide onsite representation for those clinics subjected to
onsite field audits for cost report, medical necessity determinations,
and post payment claims review. |
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| Recertification
Audits |
| Each
Rural Health Clinic is subject to a recertification audit by the
State Agency. RHA will remind clinics to be prepared for the
audits on the anniversary of previous audit. RHA will provide technical
assistance to the clinic if problems arise during the audit. RHA
will assist the clinic if discrepancies occur with an action plan
to correct deficiencies. |
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| Billing
and Claims Submission |
| RHA
will provide technical assistance to clinic staff responsible for
submitting claims to the Part A Fiscal Intermediary. Training of
staff will be either onsite or by teleconference. RHA will assist
the clinic in resolving claims payment and/or denial issues. RHA
will coordinate with the Part A Fiscal Intermediary to research
and resolve outstanding claims or disputed denials. |
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| Conversion/Startup
Services |
| RHA
will assist existing medical clinics and newly organized medical
practices in becoming a certified Rural Health Clinic or Federally
Qualified Health Clinic. RHA will prepare and submit CMS 855A and
other supportive documentation, provide personnel policy, procedure
manuals, and patient care policies. RHA will perform a pre-survey
review prior to site survey and provide a Professional Advisory
Committee orientation. RHA will prepare pro-forma budget in concert
with the clinic's accountant and complete the financial feasability
study (projected cost report) upon request of the Fiscal Intermediary. |
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