Rural Health Clinics

Purpose of Rural Health Clinics (RHC): RHC legislation had two main purposes: to improve access to primary health care in rural, underserved communities; and, to promote a collaborative model of health care delivery using physicians, nurse practitioners, and physician assistants. Federally certified RHCs are primary care practices that use a particular practice model and are reimbursed in a special way by CMS and state Medicaid programs.

CMS uses state surveys and licensure agencies to review and recommend designation of private or nonprofit clinics meeting conditions for participation and certification as RHCs. RHCs are important safety net providers since the populations for whom they receive enhanced reimbursements are Medicaid and Medicare beneficiaries.

NOSORH’s Primary Care Committee works to plan activities and resources to build the capacity of SORH to provide technical assistance and work with RHCs.

Click here for more information about the committee.

Modules

Module 1:
An Introduction to the Rural Health Clinic Program

This module is designed primarily for State Office of Rural Health (SORH) staff new to the Office, new to working with primary care and/or new to working with Rural Health Clinics.

Module 2:
Learning about the Technical Assistance Needs of Certified Rural Health Clinics

This module is primarily designed for State Office of Rural Health (SORH) staff who are new to the Office, new to working with Rural Health Clinics (RHCs), are not working actively with RHCs, or simply want to learn more about RHCs.

Module 3:
Helping SORH Make Decisions about Providing Technical Assistance and Support to Rural Health Clinics and Other Rural Primary Care Providers

This module is designed primarily for State Office of Rural Health (SORH) directors and team members interested in the development and implementation of technical assistance for rural primary care providers including Rural Health Clinics (RHCs). Although RHCs are central in this module, general business principles are applicable to most primary care provider types. Some content may be appropriate to share with partners, stakeholders, and/or community members.

Module 4:
Helping RHCs Work Effectively with Other Key Rural Health Providers

This module is designed for State Office of Rural Health (SORH) staff with some experience working with Rural Health Clinics (RHCs); Federally Qualified Health Centers (FQHCs), health professional shortage designations; the National Health Service Corps; the Critical Access Hospital program; pharmacy programs; rural and referral hospitals; Emergency Medical Systems (EMS); and other rural health providers.

Module 5:
RHC Performance Measurement and Quality Improvement

This module is designed for State Office of Rural Health (SORH) staff with experience and interest in working with Rural Health Clinics (RHCs) in the areas of program evaluation, quality improvement, quality assurance, and performance improvement.

Module 6:
Incorporating Behavioral and Mental Health Services in a Rural Health Clinic (RHC)

This module is designed for State Office of Rural Health (SORH) staff with some experience and interest in working with RHCs to provide information and models for successfully supporting or incorporating behavioral health (BH) and mental health (MH) services into an RHC. In addition, this module will increase the general knowledge of rural BH.

Independent Rural Health Clinic (RHC) Institute

In partnership with the State Offices of Rural Health and presented by Stroudwater Associates, the Independent RHC Institute is an eight-part series on maximizing efficiency and driving operations for independent RHCs.

• Part 1: Scheduling
  Don’t sweat the small stuff. Manage no-shows, last-minute cancellations, and bottlenecks to improve your overall patient throughput. 
  Objectives:
  1. Navigate scheduling strategies to mitigate no-shows and avoid revenue loss
  2. Develop an effective no-show policy for both patients and staff
  3. Explore automation and best practices
  View: Recording | PowerPoint Slides

• Part 2: Scheduling Templates and Staffing
  Boost productivity across your practice by building efficient scheduling templates & optimizing staffing.  
  Objectives:
  1. Explore scheduling template concepts
  2. Learn how to conduct a time study
  3. Revamp your process to increase access to primary care services
  View: Recording | PowerPoint Slides

• Part 3: Evaluation of Service Offerings
  Strategically structure your service offerings for future growth and profitability. 
  Objectives:
  1. Address community needs & understand your market
  2. Identify operational concerns (i.e., staffing, physical space, med staff)
  3. Analyze and integrate your proforma
  View: Recording | PowerPoint Slides

• Part 4: Vendor Management & Payor Contracting
  When properly managed, outsourcing can help improve patient care and maximize efficiencies. Learn to identify, manage, and monitor your vendor relationships and how to navigate the complexities of RHC billing and contract management.  
  Objectives:
  1. Identify and manage risk
  2. Optimize your contracts and fee schedules
  3. Build a centralized process for managing and tracking contracts
  View: Recording | PowerPoint Slides

• Part 5: Community Relations & Marketing Your RHC
  Learn strategies to build relationships with your referring providers, deliver promotional messaging, and resolve issues before they arise.
  Objectives:
  1. Prioritize outreach to important referral sources
  2. Build an effective referral management process
  3. Identify market expansion opportunities
  View: Recording | PowerPoint Slides

• Part 6: RHC Specific-Billing
  RHCs have a unique set of billing rules that are different from traditional physician billing practices. This session will explain these differences and the requirements needed for an RHC to receive the designated All-Inclusive Rate (AIR) payment.
  Objectives:
  1. Identify requirements for RHC operations
  2. Demonstrate specific billing rules required for an RHC as compared to traditional clinic billing
  3. Identify nuances in the revenue cycle unique to Government vs. Commercial payors
  View: Recording | PowerPoint Slides

• Part 7: Revenue Cycle Management and Measurement
  Now more than ever, RHCs are looking for ways to improve their cash position and streamline billing and collections. One such opportunity for improvement is through revenue cycle activities. This session will focus on best practice strategies for effective revenue cycle processes.
  Objectives:
  1. Identify revenue cycle activities needed for effective cash collections
  2. Learn best practices for engaging with patients about bills
  3. Understand how to develop and utilize key reports for monitoring revenue cycle activities
  View: Recording | PowerPoint Slides

• Part 8: Cost-Report Basics (coming soon!)
  While most independent RHCs will use a third-party administrator to create their cost reports, it is important to understand the nuances of their cost reports and adequately categorize costs.
  Objectives:
  1. Be able to provide your TPA with the relevant information to prepare a good cost report
  2. Properly review your cost report and understand how your reimbursement is tied to your cost report
  3. Utilize your cost report for expense planning
  View: Recording | PowerPoint Slides

Reports

NOSORH CA Rural Health Clinic Technical Assistance Project Report – April 2011

During Year 7 of the NOSORH Cooperative Agreement the National Organization of State Offices of Rural Health entered its second year of activities to build the technical assistance capacity of State Offices of Rural Health for certified Rural Health Clinics. This report will provide an overview of the activities conducted, highlights some of the lessons learned during the year, and outlines the future cooperative work of NOSORH with ORHP, its partners and State Offices of Rural Health.

External Resources

Rural Health Clinic Technical Assistance

• HRSA Health Professional Shortage Area Designation
• Starting a Rural Health Clinic: A How-to Manual (Chapters 1 & 2)
• QPP Support for Small Practices

RHC Policies and Procedures

• HSA – Advisory Council Agenda
• HSA – Conducting the Annual Advisory Committee Meeting
  
• HSA – Policies and Procedures
  
• HSA – RHC Compliance and Regulations
  
• RHC – Items Checklist
• Evaluation of Clinic Medical Records
  
• Chart Review Template
• RHC – Table of Contents

Emergency Preparedness

• Columbia University – Emergency Preparedness Toolkit for CHCs and Community Practice Sites
• The Compliance Team – Emergency Preparedness Surveyor Guidelines
• The Compliance Team – Emergency Preparedness Training – Kate Hill
• CMS – Emergency Preparedness Rule Table Requirements by Provider Type
• The Compliance Team – Emergency Preparedness Checklist
• RHC / FQHC – Emergency Operations Plan Template

Webinars

• Engaging Rural Health Clinics in Value-Based Care
• Understanding How to Conduct Rural Health Clinic Practice Assessments
• How to Use Data for Decision Making in Rural Health Clinics

For a list of additional RHC resources, click here.