CMS Pub. 100-02, ch. 13, § 100

Commingling refers to the sharing of RHC or FQHC space, staff (employed or

contracted), supplies, equipment, and/or other resources with an onsite Medicare Part B

or Medicaid fee-for-service practice operated by the same RHC or FQHC physician(s)

and/or non-physician(s) practitioners. Commingling is prohibited in order to prevent:

• Duplicate Medicare or Medicaid reimbursement (including situations where the

RHC or FQHC is unable to distinguish its actual costs from those that are

reimbursed on a fee-for-service basis), or

• Selectively choosing a higher or lower reimbursement rate for the services.

RHC and FQHC practitioners may not furnish or separately bill for RHC or FQHC-covered professional services as a Part B provider in the RHC or FQHC, or in an area

outside of the certified RHC or FQHC space such as a treatment room adjacent to the

RHC or FQHC, during RHC or FQHC hours of operation.

If an RHC or FQHC practitioner furnishes an RHC or FQHC service at the RHC or

FQHC during RHC or FQHC hours, the service must be billed as an RHC or FQHC

service. The service cannot be carved out of the cost report and billed to Part B.

If an RHC or FQHC is located in the same building with another entity such as an

unaffiliated medical practice, x-ray and lab facility, dental clinic, emergency room, etc.,

the RHC or FQHC space must be clearly defined. If the RHC or FQHC leases space to

another entity, all costs associated with the leased space must be carved out of the cost

report.

RHCs and FQHCs that share resources (e.g., waiting room, telephones, receptionist, etc.)

with another entity must maintain accurate records to assure that all costs claimed for

Medicare reimbursement are only for the RHC or FQHC staff, space, or other resources.

Any shared staff, space, or other resources must be allocated appropriately between RHC

or FQHC and non-RHC or non-FQHC usage to avoid duplicate reimbursement.

This commingling policy does not prohibit a provider-based RHC from sharing its health

care practitioners with the hospital emergency department in an emergency, or prohibit

an RHC practitioner from providing on-call services for an emergency room, as long as

the RHC would continue to meet the RHC conditions for coverage even if the practitioner

were absent from the facility. The RHC must be able to allocate appropriately the

practitioner's salary between RHC and non-RHC time. It is expected that the sharing of

the practitioner with the hospital emergency department would not be a common

occurrence.

The A/B MAC has the authority to determine acceptable accounting methods for

allocation of costs between the RHC or FQHC and another entity. In some situations, the

practitioner’s employment agreement will provide a useful tool to help determine

appropriate accounting.