Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.44 - Rural Health Clinics and Federally Qualified Health Centers
Rule 37.86.4402 - RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, VISITS AND ENCOUNTERS
Universal Citation: MT Admin Rules 37.86.4402
Current through Register Vol. 18, September 20, 2024
(1) A visit is a face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC health professional for the purpose of providing RHC or FQHC services. Reimbursement is available for one encounter per day per eligible member unless it is necessary for the member:
(a) to be
seen by different health professionals with different specialties; or
(b) to be seen multiple times per day due to
unrelated diagnoses.
(2) Encounters with the same primary diagnosis are not considered separately billable visits, regardless of the health professional providing the service.
AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
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