Profile of Rural Health Clinics: Medicare Payments & Common Diagnoses

With over 3,900 certified sites located across the country, Rural Health Clinics (RHCs) are an important component of the rural health care infrastructure. This Findings Brief presents a summary profile of Medicare billing and reimbursement activity for independent and provider-based RHCs, using data extracted from 2009 Medicare outpatient provider claims.

Key findings:

• In 2009, RHCs filed over 8.1 million claims to Medicare with total charges of $869 million, and $809 million due in reimbursement from all sources (Medicare, patient, other). 
• The majority of RHC Medicare claims are for clinic visits (89%) and another 9% are for home, skilled nursing facility (SNF) or long-term care (LTC) visits. Revenue codes for behavioral health, visiting nurse services, and telemedicine are rarely billed. 
• The most common medical conditions for Medicare beneficiaries seen by RHCs in 2009 include hypertension, diabetes mellitus, respiratory infections and diseases of the heart. 

This Findings Brief is the first in a series on RHCs which will profile the distribution and characteristics of individual clinics as well as the characteristics of Medicare beneficiaries served by RHCs.

Contact information:
Andrea Radford, DrPH
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919-966-7922
aradford@schsr.unc.edu

Additional Resource of Interest:

• Are Rural Health Clinics Part of the Rural Safety Net? (Policy Brief)
• Communities Served by Rural Medicare Dependent Hospitals
• More information about the North Carolina Rural Health Research & Policy Analysis Center