Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1129 - RURAL HEALTH CLINIC SERVICES
PAYMENT FOR RURAL HEALTH CLINIC SERVICES
Section 1129.51 - General payment policy

Universal Citation: 55 PA Code ยง 1129.51

Current through Register Vol. 54, No. 44, November 2, 2024

(a) Payment will be made for rural health clinic services rendered at the clinic, at a hospital or at the place of residence of the patient.

(b) Payment for rural health clinic services will be made on the basis of an all-inclusive visit fee established by the Medicare carrier. When the cost for a service provided by the clinic is included in the established visit fee, the practitioner rendering the service shall not bill the MA Program for it separately.

(c) An adjustment to the all-inclusive visit fee will be made when the Medicare carrier determines the difference, if any, between the total payment due the clinic and the total payment made during the reported period. The adjustment will be made as follows:

(1) If the clinic has been underpaid, the Department will make a lump sum payment for the amount due.

(2) If the clinic has been overpaid, the clinic shall make a lump sum payment to the Department for the amount due. A repayment plan not to exceed 1 year will be arranged by the Department at the request of the clinic if the Department is satisfied that a lump sum payment would impose severe financial hardship on the clinic.

Disclaimer: These regulations may not be the most recent version. Pennsylvania may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.