RHC Billing Guide for Preventative Services unde the Affordable Care Act

This Special Edition article by the Medicare Learning Network is based on Change Request (CR) 7038 and CR 7208, and it provides a billing guide for FQHCs and RHCs. It explains how RHCs should bill for certain preventive services under the Affordable Care Act. Effective for dates of service on or after January 1, 2011, coinsurance and deductible are not applicable for the Initial Preventive Physical Examination (IPPE) provided by RHCs. However, to ensure coinsurance and deductible are not applied, detailed Healthcare Common Procedure Coding System (HCPCS) coding must be provided for preventive services recommended by the United States Preventive Services Task Force (USPSTF) with a grade of A or B. The Affordable Care Act also waives the deductible for planned colorectal cancer screening tests that become diagnostic.