471 Neb. Admin. Code, ch. 34, § 004
NMAP will pay for services provided by Rural Health Clinics in compliance with Section 1902 (bb) of the Social Security Act. The Department assures that payments to all RHCs will result in a payment to the clinic in the amount which is at least equal to the Prospective Payment System.
Definitions means the following definitions apply within this chapter:
Encounter means a face-to-face visit between a Medicaid-eligible patient and a physician, physician assistant, nurse practitioner, nurse midwife, specialized nurse practitioner, visiting nurse, clinical psychologist, or clinical social worker during which an FQHC service is rendered. Encounters with more than one health professional and multiple encounters with the same health professional which take place on the same day and at a single location constitute a single visit, except for cases in which the patient, subsequent to the first encounter, suffers an illness or injury requiring additional diagnosis or treatment.
Encounter Payments means PPS rate paid to the RHC by the Department multiplied by the number of encounters billed.
Encounter Rate means the all-inclusive PPS rate that the Department reimburses the RHC for an encounter.
Independent Rural Health Clinic means A clinic that is free standing with no association to a hospital, nursing facility, or home health agency.
Medicare Cost Report means the report filed by each RHC provider with its Medicare intermediary as required by Chapter 9 of the Medicare Rural Health Clinic and Federal Qualified Health Center Manual.
Prospective Payment System (PPS) means the payment system where in a reimbursement rate is paid for services provided.
Provider-Based Rural Health Clinic means a rural health clinic that is an integral part of a hospital, nursing facility, or home health agency that is participating in Medicare and is licensed, governed and supervised by the facility.
471 Neb. Admin. Code, ch. 34, § 004