Rural Health Clinics don’t bill like a typical physician practice. Medicare pays your clinic an all-inclusive rate for each qualifying visit, claims go out on the institutional 837I (UB-04) instead of a CMS-1500, and the rules for care management, telehealth and mental health visits keep changing. When a single visit is coded or billed the wrong way, the clinic can lose the whole payment for that encounter.
AMS Solutions provides Rural Health Clinic billing services for independent RHCs and for provider-based clinics owned by rural hospitals. We handle coding review, clean claim submission, payment posting, denial follow-up and reporting, so your staff can focus on patients. We’ve been in medical billing since 1992, our coders hold AAPC credentials, and we work under a signed business associate agreement (BAA) for covered services.
Why RHC Billing Is Different
Most billing companies are built around the physician fee schedule. RHC billing follows a different set of Medicare rules, and small mistakes carry a bigger cost because payment is tied to the visit, not to each line.
One all-inclusive rate per visit
Medicare pays an RHC an all-inclusive rate (AIR) for each medically necessary, face-to-face visit with an RHC practitioner: a physician, nurse practitioner, physician assistant, certified nurse-midwife, clinical psychologist, clinical social worker, marriage and family therapist or mental health counselor. Generally only one visit per patient per day is paid. Exceptions include a medical visit and a mental health visit on the same day, an Initial Preventive Physical Examination plus a separate medical or mental health visit, intensive outpatient services on the same day as a medical visit, and a new illness or injury that occurs after the first visit that day.
Most RHCs are subject to a national per-visit payment limit set by the Consolidated Appropriations Act, 2021. The limit is $165 in 2026, rising to $178 in 2027 and $190 in 2028, and is updated by the Medicare Economic Index (MEI) after that. Certain provider-based RHCs have a clinic-specific limit instead: those that were part of a hospital with fewer than 50 beds on December 31, 2020 (and still are), and that were enrolled in Medicare, or had an enrollment application received, by that date. Their limit is their own 2020 rate increased each year by the MEI, or the national limit if that is higher.
Institutional claims with RHC-specific coding
RHC claims go to Medicare on the 837I with type of bill 71X. Visit lines use revenue codes in the 052X range, with 0900 for mental health services. Every service line needs a HCPCS code, and the line carrying the qualifying visit still needs the CG modifier, while care management codes go on 052X lines without it. A claim that looks fine to a practice-management system built for professional billing can still be returned or underpaid.
Cost sharing and preventive services
The Part B deductible and 20% coinsurance (based on the clinic’s charges) apply to most RHC visits. Both are waived for the Initial Preventive Physical Examination, the Annual Wellness Visit, most USPSTF A- and B-rated preventive services, and flu, pneumococcal, hepatitis B and COVID-19 vaccines. Getting this right on the claim and on the patient statement protects your revenue and your patients’ trust.
An annual cost report
Medicare reconciles RHC payment through a yearly cost report: Form CMS-222-17 for independent clinics, or the Worksheet M series of the hospital’s CMS-2552-10 for provider-based clinics. Part B flu, pneumococcal, hepatitis B and COVID-19 vaccines and their administration are now billed on the claim at the time of service and reconciled on the cost report. Accurate visit counts and charges from your billing system are the foundation your cost report preparer relies on.
RHC Billing Rules We’re Tracking in 2026
RHC billing rules changed repeatedly in 2025 and 2026. Our team keeps your claims current with each update, including:
- Care management codes. G0511 is not accepted for dates of service after September 30, 2025. RHCs now report individual care management codes, which Medicare pays at the national non-facility physician fee schedule rate.
- Collaborative care and virtual communication. Since January 1, 2026, psychiatric collaborative care is reported with 99492, 99493, 99494 or G2214 (replacing G0512), and virtual communication services with 98016, G2010 or G2250 (replacing G0071).
- Telehealth. Under current law, RHCs can furnish non-behavioral distant site telehealth services through December 31, 2027. For dates of service on or after October 1, 2026, they are billed with the individual CPT or HCPCS code and modifier 95 or 93 instead of G2025. The in-person requirement for mental health telehealth is delayed through the same date.
- Transitional care management. TCM furnished by an RHC practitioner is paid as an RHC visit.
- Medicaid PPS. State Medicaid programs must pay RHCs under the prospective payment system in Section 1902(bb) of the Social Security Act, or an alternative payment methodology agreed to by the state and the clinic that pays at least as much. Rules vary by state, and we bill to each program’s requirements.
- Medicare Advantage. Unlike FQHCs, RHCs do not receive a Medicare wraparound payment for Medicare Advantage visits, so plan contract terms and denial follow-up directly affect what the clinic collects.
Our Rural Health Clinic Billing Services
You can hand us the full revenue cycle or have us fill the gaps your team doesn’t have time for. Our RHC billing services include:
- Coding and charge review by AAPC-credentialed coders, including qualifying-visit rules, same-day visits and preventive services.
- Claim preparation and submission on the 837I for Medicare and in each Medicaid and commercial payer’s required format.
- Payment posting and reconciliation so AIR payments, care management payments and patient balances match what was billed.
- Denial management and A/R follow-up with root-cause tracking to reduce repeat denials.
- Credentialing and enrollment for the clinic and its practitioners with Medicare, Medicaid and commercial plans.
- Patient statements and customer service that reflect the correct deductible and coinsurance rules.
- Monthly reporting on visits, collections, A/R days and denial trends, plus the visit and charge data your cost report preparer needs.
Provider-Based RHCs and Rural Hospitals
Many rural hospitals, including critical access hospitals, own one or more RHCs. Their business offices often manage inpatient, outpatient, swing-bed and clinic claims with a small team, and clinic claims tend to fall behind first when someone leaves. We can take over RHC billing on its own, clear a clinic A/R backlog, or support your staff through an EHR conversion or a leadership change. If your hospital is working through its own billing challenges, see our guide to critical access hospital billing.
How Working With AMS Solutions Works
- Free billing analysis. We review a sample of your RHC claims, denials and A/R and send written findings within 5 business days.
- Onboarding. We work in your existing EHR and practice-management system, confirm payer enrollment, and set up a clear hand-off with your front desk and clinical staff.
- Ongoing billing. Your AMS billing team submits claims, works denials and A/R, and answers patient billing questions.
- Reporting and check-ins. You get regular reports and a standing review call to talk through trends and rule changes.
Compliance and Data Security
AMS Solutions works under a signed business associate agreement (BAA) for covered services, and our coding staff hold AAPC credentials. Coding decisions are made against the documentation in the record: we don’t code a visit the documentation won’t support.
Frequently Asked Questions About RHC Billing
Medicare pays an RHC an all-inclusive rate (AIR) for each qualifying face-to-face visit with an RHC practitioner, rather than paying each service from the physician fee schedule. Most RHCs are subject to a national per-visit payment limit, which is $165 in 2026. Payment is then reconciled through the clinic’s annual cost report.
Yes. The Part B deductible and 20% coinsurance (based on the clinic’s charges) apply to most RHC visits. They are waived for the Initial Preventive Physical Examination, the Annual Wellness Visit, most USPSTF A- and B-rated preventive services, and flu, pneumococcal, hepatitis B and COVID-19 vaccines.
Usually Medicare pays one visit per patient per day. Exceptions include a medical visit and a mental health visit on the same day, an Initial Preventive Physical Examination plus a separate medical or mental health visit, intensive outpatient services on the same day as a medical visit, and a new illness or injury that occurs after the patient’s first visit that day.
RHCs stopped billing care management with G0511 after September 30, 2025, and now report the individual care management codes. Since January 1, 2026, psychiatric collaborative care is reported with 99492, 99493, 99494 or G2214, and virtual communication services with 98016, G2010 or G2250. Medicare pays these codes at the national non-facility physician fee schedule rate, outside the AIR.
Yes. Under current law, RHCs can bill non-behavioral distant site telehealth services through December 31, 2027. For dates of service on or after October 1, 2026, RHCs report the individual CPT or HCPCS code with modifier 95 or 93 instead of G2025. The in-person visit requirement for mental health telehealth is also delayed through December 31, 2027, under the Consolidated Appropriations Act, 2026.
Yes. We work with independent clinics and with provider-based RHCs owned by critical access and other small rural hospitals. We can handle the clinic’s claims on their own or support your hospital business office alongside them.
Request a Free RHC Billing Analysis
Tell us about your clinic and we’ll review your RHC claims, denials and A/R, then send written findings within 5 business days. Prefer to talk? Call 866-973-2221.