CMS Pub. 100-02, ch. 13, § 40.1

RHC or FQHC visits may take place in:

• the RHC or FQHC,

• the patient’s residence (including an assisted living facility),

• a Medicare-covered Part A SNF (see Pub. 100-04, Medicare Claims

Processing Manual, chapter 6, section 20.1.1),

• the scene of an accident, or

• the location of the patient during a Hospice election, including a patient’s

residence or a Medicare certified facility

RHC and FQHC visits may not take place in:

• an inpatient or outpatient department of a hospital, including a CAH, or

• a facility which has specific requirements that preclude RHC or FQHC

visits (e.g., a Medicare comprehensive outpatient rehabilitation facility,

a hospice facility (except when the RHC/FQHC is furnishing hospice

attending physician services during a hospice election), etc.).

Qualified services provided to a RHC or FQHC patient are considered RHC or FQHC

services if:

• the practitioner is compensated by the RHC or FQHC for the services provided;

• the cost of the service is included in the RHC or FQHC cost report; and;

• other requirements for furnishing services are met.

This applies to full and part time practitioners, and it applies regardless of whether

the practitioner is an employee of the RHC or FQHC, working under contract to

the RHC or FQHC, or is compensated by the RHC or FQHC under another type of

arrangement.

RHCs and FQHCs should have clear policies regarding the provision of services in

other locations and include this in a practitioner’s employment agreement or

contract. RHCs and FQHCs providing RHC or FQHC services in locations other

than the RHC or FQHC facility must continue to meet all certification and cost

reporting requirements. Services in other locations may be subject to review by the

A/B MAC. RHC or FQHC services furnished by an RHC or FQHC practitioner

may not be billed separately by the RHC or FQHC practitioner, or by another

practitioner or an entity other than the RHC or FQHC, even if the service is not a

stand-alone billable visit. Services furnished to patients in any type of hospital

setting (inpatient, outpatient, or emergency department) are statutorily excluded

from the RHC/FQHC benefit and may not be billed by the RHC or FQHC.