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KMAP BULLETIN: RHC/FQHC Global Billing

Date: 06/17/20

KMAP RHC/FQHC BULLETIN 20031 (PDF)

Effective with dates of service on and after July 1, 2020, the following global billing guidelines will apply to Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) providers: Surgical procedures furnished in an RHC or FQHC by an RHC or FQHC practitioner are considered RHC or FQHC services.

Procedures are included in the payment of an otherwise qualified visit and are not separately billable. If a procedure is associated with a qualified visit, the charges for the procedure go on the claim with the visit. Global billing requirements do not apply to RHCs and FQHCs. Surgical procedures furnished at locations other than RHCs or FQHC providers may be subject to KMAP global billing requirements. If an RHC or FQHC furnishes services to a patient who has had surgery elsewhere and is still in the global billing period, the RHC or FQHC must determine if these services have been included in the surgical global billing. RHCs and FQHC providers may bill for a visit during the global surgical period if the visit is for a service not included in the global billing package. If the service furnished by the RHC or FQHC was included in the global payment for the surgery, the RHC or FQHC may not bill for the same service.

Services not included in the global surgical package are listed in the KMAP Professional provider manual, and include, but are not limited to:

  • Initial consultation by the surgeon to determine the need for major surgery;
  • Visits unrelated to the diagnosis for which the surgical procedure is performed (unless the visit occurs due to complications of the surgery);
  • Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery.

Note: The effective date of the policy is July 1, 2020. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.