Medicare reimbursement to RHCs is based on interim payments of an All Inclusive Reimbursement Rate (AIRR) as determined by a cost report. The only exception to this is that an RHC operated as a provider-based facility by a hospital with fewer than 50 beds is exempt from the per visit payment cap. The reimbursement rate for all RHCs is subject to practitioner productivity standards. Medicare patients are responsible for 20 percent of the allowable charges, subject to the clinic's sliding fee scale. The patient does not pay 20 percent of the AIRR amount.