Section He-W 537.08 - Payment for Services(a) Payment for the RHC and FQHC services described in He-W 537.05 above shall be made on the basis of an all-inclusive rate per visit.(b) RHC and FQHC providers shall bill for the services described in He-W 537.05 above utilizing the encounter code assigned by the department of health and human services.(c) RHC and FQHC providers shall bill for services other than the outpatient RHC/FQHC services described in He-W 537.05 above utilizing the appropriate procedure code listed in the current edition of Current Procedural Terminology.(d) Recipient encounters with more than one health professional, or multiple encounters with the same health professional, which take place on the same day for the same diagnosis or treatment, shall be counted as one visit.(e) RHCs and FQHCs shall bill for only one visit per recipient per day, except for cases in which the patient, subsequent to the first visit, suffers an illness or injury requiring additional diagnosis and treatment.(f) Payment shall be made in accordance with encounter code rates established by the department of health and human services.(g) Independent RHCs and RQHCs shall submit claims for payment to the department of health and human services' fiscal agent on form HCFA 1500.(h) Hospital-based RHCs shall submit claims for payment to the department of health and human services' fiscal agent on form UB 92, also known as HCFA 1450.(i) The RHC and FQHC shall maintain supporting records, in accordance with He-W 520.(j) The form HCFA 1500 in (g) above, and the form UB 92, also know as HCFA 1450 in (h) above, pursuant to 42 CFR 424.32, shall include: (1) Patient and insured information;(2) Physician or supplier information; andN.H. Admin. Code § He-W 537.08
(See Revision Note at chapter heading He-W 500); ss by #4884, eff 8-1-90, EXPIRED: 8-1-96
New. #6725, eff 4-1-98