Rural Health Clinic (RHC) Billing PUB-100 40.5

January 4th, 2018 - Find-A-Code
Categories:   Laboratory|Pathology   Billing  
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For independent RHCs, laboratory services provided in the RHC’s laboratory are not included in the all-inclusive rate payment to the RHC and may be billed separately to the A/B MAC (B). This includes the six basic laboratory tests required for certification as well as any other laboratory tests provided in the RHC laboratory.

Note: If the RHC sends laboratory services to an outside laboratory, the outside laboratory bills the A/B MAC (B) for the tests. If the RHC laboratory becomes certified as a clinical laboratory, it bills all laboratory tests performed in its laboratory to the laboratory’s A/B MAC (B). Laboratory tests are not included as RHC costs nor as part of the RHC all-inclusive rate payment.

For provider-based RHCs the rules in the preceding paragraph apply with the following exception. The provider bills tests provided in its laboratory to the A/B MAC (A).

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