RHC Financial and Operational Improvement
RHC Billing and Coding Resources
RHC Advanced Coding and Billing
May 8, 2025
What You Will Learn:
This informative webinar goes beyond RHC coding and billing basics to explore more advanced billing topics, such as preventative services, care management services, hospice services, and medical and mental health telemedicine. This is an opportunity to enhance your knowledge and sharpen your coding and billing skills in these critical areas.
Presenter: Patty Harper, Principal, InQuiseek Consulting
RHC Coding and Billing Fundamentals
March 4, 2025
What You Will Learn:
Join Patty Harper in an engaging webinar where she will dive into the essential principles of coding and billing specific to rural health clinics. Whether you are an experienced billing professional looking to brush up on your skills or a newcomer eager to learn the ropes, this curriculum has got you covered. Participants can expect a comprehensive overview of the foundational aspects of RHC Medicare coding, including practical examples and insights that will enhance their understanding of the billing process.
Presenter: Patty Harper, Principal, InQuiseek Consulting
- Noridian Healthcare Solutions
Noridian acts as the Medicare Administrative Contractor (MAC) for Oregon and other Western states. They publish an RHC Medicare billing guide for Medicare related billing questions. - CMS Rural Health Clinic Center
- Medicare Claims Processing Manual, Chapter 18 – Preventive and Screening Services
- Medicare RHC Benefit Policy Manual
- Medicare RHC Claims Processing Manual
- Medicare Billing guidance for Preventative Services
- Provider Wraparound Data Template | Note: Both the “Cover Page” and “Raw Data” tabs must be completed for submissions.
- Helpful Presentations
- Basic RHC Billing v. 2020: Charles James, Jr. North American HMS
- Advanced RHC Billing and Coding v.2020 Charles James, Jr North American HMS
- Billing Basics: Oregon Health Authority (OHA) presentation on billing information for all providers who serve Medicaid clients.
- FQHC-RHC Provider Guide 8/31/2015: Two page document with links to resources at the Oregon Health Authority’s Medical Assistance Programs (OHA MAP). FQRC-RHC Program page.
- Oregon Medicaid Professional Billing Instructions: includes RHC billing submission process to OHA MAP.
- For current Oregon Administrative RHC Rules refer to: OHA Health System Division: Medical Assistance Programs- Chapter 410
- If in doubt of which claim format to use, contact OHA MAP Provider Services | 800-336-6016 | for assistance.
- Oregon Medicaid Prepaid Health Plan Supplemental Payments (“Wraparound”)
Federal rule requires OHA MAP to make supplemental payments (“wraparound payments”) to RHCs that contract with Prepaid Health Plans (PHP). The wraparound payment represents the difference, if any, between the payment received by the RHC from the PHP for treating the enrolled patient and the payment to which the RHC would be entitled if they had billed MAP directly for these encounters according to the RHC’s Prospective Payment System (PPS) encounter rate (OAR 410-147 [0460]). The OHA MAP Policy Analyst will coordinate this process with each RHC upon enrollment with Oregon Medicaid. Contact: Eric Larson, Fiscal Auditor | 503-945-5991. - Oregon Medicaid and Change-in-Scope: A change in the scope of RHC services may occur if the RHC has added, dropped or expanded any service since initial certification. Please see 410-147 [0362] Change in Scope of Services for further details on Oregon Medicaid Change in Scope.
Oregon RHC Financial Benchmarking and Analysis Training
August 5 & 6, 2025
What You Will Learn:
Presenting and discussing the 2025 update to the 2024 RHC Financial Benchmarking and Analysis Report.
This report includes the previous year's data with the current year's updates for the newly completed and released Medicare Cost Reports. The first session discusses the purpose of the report, the background of the data source and the development of Oregon-specific RHC benchmarks. The remainder of the first session and most of the second moves into a discussion of various cost, payor mix, visit volume, provider mix, provider cost and charge statistics and benchmarks. Reporting is broken down between freestanding and provider-based RHCs. In addition, there are comparisons to the previous year's reporting. In each area, we present the results of the statistical analysis as well as share best practices deployed by higher-performing providers in Oregon and the rest of the United States.
The final portion of this two-part series focuses on cost report updates and strategies to assist in ensuring compliance with reporting requirements and improving overall reimbursement.
Presenter: Ralph Llewellyn, is a Partner with Eide Bailly LLP and serves as their Partner in Charge of Critical Access Hospitals. He began his career as a rural hospital CFO. For the past 27 years, he has been with Eide Bailly, where he conducts operational assessments and assists providers in enhancing financial and operational performance. He also assists providers in developing strategies for maintaining compliance with Medicare and other regulations in rural settings. Ralph is a frequent speaker at state, regional and national events.
RHC Financial Health Winter Learning Series
This winter, the Office of Rural Health will host a series of online financial sessions led by industry expert Patty Harper. These sessions are designed to enhance accuracy, improve compliance, and increase confidence in revenue cycle practices. Catering to both seasoned professionals and newcomers to the field, this series will provide practical tools, real-world case studies, and timely updates to ensure participants remain proficient in the continually evolving healthcare landscape.
Register for each session below:
RHC Fee Schedule Maintenance and Methodologies
Nov. 4 | Recording | Slides
Join Patty for a discussion of basic strategies for fee-setting methodologies while considering the unique aspects of RHC cost-sharing and reimbursement. She will also discuss how to maintain a fee schedule and how to know when a national update has been made that requires fee schedule maintenance.
2026 RHC Coding and Billing Update: Navigating Critical Changes
Dec. 2 | Recording | Slides
This session covers RHC coding and billing basics as well as any relevant changes from the recently finalized 2026 Medicare Physician Fee Schedule Final Rule. Expect changes to care management, telehealth, vaccine administration, and medical economic index factors.
Mastering RHC Advanced Billing
Jan. 6 | 10:00 a.m. – 11:00 a.m. PT | Register here
Start the new year with us as we dive into the details of RHC advanced billing. We will discuss those pesky negative remittance advice and tips for 2026. This webinar will also offer more detailed guidance on the 2026 MPFS final rule and other advanced billing topics.
Telehealth Tune-Up for RHCs
Feb. 3 | 10:00 a.m. – 11:00 a.m. PT | Register here
Telehealth: will it be the death of us, or will it be our answer to expanded access to care? Join us for this session to find out the latest and greatest information on RHC telehealth. We will discuss telehealth terminology and provide billing examples for originating telehealth, distant site medical telehealth, and distant site mental health telehealth services.
Strategies for Implementing and Enhancing Integrated Behavioral Health Services
March 3 | 10:00 a.m. – 11:00 a.m. PT | Register here
Adding behavioral health in the RHC can be challenging, especially with so many soundbites on the topic. What is integrated behavioral health (IBH)? How are RHCs paid for IBH, considering the changes to RHC care management coding? Join us for a discussion on how to provide these much-needed services while optimizing best practices clinically and financially.
Presenter:
Patty Harper
Patty Harper is a principal of InQuiseek Consulting. She has 28 years of health care experience in the areas of health care finance & reimbursement, health information management, compliance, and practice management. She actively consults with rural health clinics, CAHs and rural hospitals across the country in the areas of reimbursement, revenue cycle improvement and regulatory compliance. Patty holds a B.S. from Louisiana Tech University. She is credentialed through AHIMA as a RHIA, CHTS-IM, and CHTS-PW. She is also Certified in Healthcare Compliance (CHC®). Patty is a frequent speaker and content contributor for national, state, and regional organizations on these and other rural health topics. Patty served on the NARHC Board from 2018 through 2023.
If you have any questions, contact Rondyann | Gerst@ohsu.edu | 503.312.3907.
Education Series - Unlocking the Full Potential of Your RHC with Chronic Care Management
This four-part education series, hosted by North Dakota Rural Health Clinic Network (ND Flex) and the Oregon Office of Rural Health, empowers Rural Health Clinic (RHC) staff to develop and implement a successful Chronic Care Management (CCM) program. Learn how to qualify and enroll patients, deliver high-quality CCM services, and master compliant documentation and billing practices to increase revenue and improve patient outcomes.
By completing this series, you will gain practical knowledge and confidence to deliver coordinated, comprehensive care, ultimately improving the health of your patients and the financial health of your practice.
Register for each session below:
Session One - From Idea to Impact: The Essential Building Blocks of a Successful CCM Program | Oct. 28
Chronic Care Management (CCM) is one of the most underutilized opportunities for RHCs to improve patient outcomes and drive new revenue. In this session, we’ll break down the fundamentals of CCM — who qualifies, what CMS requires, and the essential staffing and technology components. Attendees will leave with a clear roadmap of what it takes to get started and how CCM can benefit both patients and the clinic.
Session Two - Design for Success: How to Construct a Compliant and Sustainable CCM Program
Dec 9 | 10:00 a.m. – 11:00 a.m. PT or 12:00 p.m. – 1:00 p.m. CT | Register here
Once you understand the building blocks, the next step is constructing a program that works in the real world. This session covers how to develop workflows, engage staff, enroll patients, and ensure compliance with CMS documentation and billing requirements. We’ll share sample tools, policies, and processes to help you design a program that fits seamlessly into your clinic operations and sets you up for long-term success.
Session Three - Making It Work: Proven Strategies to Implement and Operationalize CCM in Your RHC
Feb 18| 10:00 a.m. – 11:00 a.m. PT or 12:00 p.m. – 1:00 p.m. CT | Register here
Even the best-designed program won’t succeed without careful implementation. This session provides practical strategies to launch and operationalize your CCM program, including training staff, integrating CCM into daily workflows, and engaging patients effectively. We’ll also tackle common barriers such as time management, staffing constraints, and patient resistance — and show you proven solutions RHCs have used to overcome them.
Session Four - Measure What Matters: Proving Value and Scaling Your CCM Program for Growth
May 5| 10:00 a.m. – 11:00 a.m. PT or 12:00 p.m. – 1:00 p.m. CT | Register here
After implementation comes the critical step of measuring impact. This session will show you how to evaluate your CCM program’s success through both financial ROI and patient outcomes. Learn how to use dashboards and scorecards, make data-driven improvements, and communicate value to stakeholders. We’ll also explore opportunities to expand into related services, such as Transitional Care Management (TCM), Remote Patient Monitoring (RPM), and Behavioral Health Integration (BHI), which will help your RHC scale its impact and sustainability.
Presenter:
Nicole Thorell, RN, MSN, FNP-C
Nicole Thorell has spent more than a decade working in rural health care, a place where her heart truly lies. As a Family Nurse Practitioner with a background in nursing administration, she’s worn many hats - serving as a Chief Nursing Officer, Director of Risk and Quality, and provider in both a Critical Access Hospital and Rural Health Clinic in Nebraska.
What’s mattered most to Nicole throughout her career is making a difference in the lives of patients and the teams who care for them. She’s led efforts to reduce hospital readmissions, strengthen patient safety, and create positive, supportive work environments. Along the way, she’s leaned on her Lean Six Sigma Green Belt training to approach challenges with curiosity, problem-solving, and a drive for continuous improvement.
Today, Nicole works as a consultant, partnering with hospitals and clinics to help them run more smoothly and deliver the best possible care to their communities. Her focus is on making everyday operations easier for providers and staff, so that rural patients can receive high-quality healthcare close to home.
If you have any questions, contact Rondyann | Gerst@ohsu.edu | 503.312.3907.