Mo HealthNet Tip on RHCs Billing Lab and Radiological Services

Mo HealthNet released the following provider tip to clarify billing for rural health clinic laboratory and radiological services. Provider tips are also available online here.

Provider-based Rural Health Clinics (RHC) should not bill the MO HealthNet Division (MHD) for the technical component of laboratory and radiological services. Section 13.1.B of the RHC manual states the technical component of laboratory and radiology are not RHC services.

Section 13.3.A states RHCs may bill the MHD using their active non-RHC NPI for the technical component of laboratory, radiology and electrocardiogram (EKG) services. RHCs will be reimbursed according to the MHD fee schedule. RHC providers not currently enrolled as an active non-RHC must complete and submit a Provider Enrollment application.

RHCs with an active non-RHC NPI are not required to submit a new application. Current NPIs may be used to bill technical components for laboratory, radiology and EKG services performed at the RHC.

When submitting claims as a non-RHC, the performing provider NPI field must be completed.

Please reference the applicable sections found in the RHC provider manual.