CMS SOM App. G, Tag J-0002

§ 491.3 Certification procedures

A rural health clinic will be certified for participation in Medicare in accordance

with subpart S of 42 CFR part 405….

§ 405.2412 Physicians' services.

Physicians' services are professional services that are furnished by either of the

following:

(a) By a physician at the RHC . . .

(b) Outside of the RHC … by a physician whose agreement with the RHC . . .

provides that he or she will be paid by the RHC . . . for such services and

certification and cost reporting requirements are met.

Interpretive Guidelines § 491.3 & § 405.2412

RHCs are permitted to provide their physician services outside the premises of the RHC,

(i.e., a patient’s home, a Part A SNF or at the scene of an accident, so long as there is a

written agreement between the RHC and the physician. Note:

• Services provided inside a mobile RHC unit are considered to be provided

inside the RHC; and

• A physician who provides RHC services is also free to provide physician

services that are not RHC services outside the RHC; in this case the physician

bills for those services separately rather than being reimbursed for them by the

RHC.

The agreement between the RHC and a physician must specifically provide that the RHC

pays the physician for the RHC services provided, and that the RHC will continue to

meet Medicare certification and cost reporting requirements.

Survey Procedures § 491.3 & § 405.2412

• Ask the leadership of the RHC, and physician(s) at the RHC when applicable,

whether or not physician services are ever provided outside the RHC facility. If yes,

ask the RHC to see the written agreement(s) and determine whether it contains the

required provisions governing payment, certification and Medicare cost reporting.