Update to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2021
PROVIDER TYPES AFFECTED
This MLN Matters Article is for Rural Health Clinics (RHCs) billing MACs for services provided to Medicare beneficiaries.
PROVIDER ACTION NEEDED
This article provides the Calendar Year (CY) 2021 payment limit for RHCs. Effective January 1, 2021, through December 31, 2021, the RHC payment limit per visit for CY 2021 is $87.52. The CY 2021 RHC payment limit reflects a 1.4 percent increase above the CY 2020 payment limit of $86.31. Make sure your billing staffs are aware of this update.
BACKGROUND
Medicare Part B payment to RHCs is 80 percent of the All-Inclusive Rate (AIR), subject to a payment limit for medically necessary medical, and qualified preventive face-to-face visits with a practitioner and a Medicare beneficiary for RHC services.
Section 1833(f) of the Social Security Act (the Act) authorizes the payment limits for a subsequent year to be increased in accordance with the rate of increase in the Medicare Economic Index (MEI). Based on historical data through the second quarter of 2020, the CY 2021 MEI is 1.4 percent.
MACs will not retroactively adjust individual RHC bills paid at a previous payment limit. However, MACs should make adjustments to the interim payment rate or a lump sum adjustment to total payments already made to take into account any excess or deficiency in payments to date.
ADDITIONAL INFORMATION
The official instruction, CR 12035, issued to your MAC regarding this change, is available at https://www.cms.gov/files/document/r10413CP.pdf.