Transitioning Physician-Based Practices to Rural Health Clinics for Long-Term Success


Wyoming County Community Health System (WCCHS), a county-owned health system in northwestern New York comprising a 47-bed acute care hospital with a 138-bed skilled nursing facility and multiple successful physician practices, was transitioning the designation of several of these practices from stand-alone entities to hospital-based practices with the CMS Rural Health Clinic (RHC) designation.

CMS outlines specific requirements around regulatory, operational, billing, and reimbursement policies that RHCs must follow, and the state of NY also has regulations for RHC-designated clinics. Since RHCs were new to the WCCHS system, key hospital stakeholders and partners needed more information about the changes the RHC designation would bring. The stand-alone physician practices were at various stages of the transition process, with different fee schedules, management, and operations, and each had to be managed individually.


WCCHS engaged Stroudwater Associates to assist with operational, billing, project management, and educational support for its RHC transition project. Our team tailored our services to fit WCCHS’s evolving needs throughout the project, including:

“Amy’s knowledge and expertise on what felt like an overwhelming project, wasn’t with their help. Having a knowledgeable and fun team to work with made for an enjoyable project and I truly enjoyed working with them.”

Katie Ksiezarczyk, CPC, CPB,
Wyoming County Community Health System.


Stroudwater’s partnership with WCCHS resulted in both qualitative and quantitative successes.

Qualitative Results

Quantitative Results

WCCHS received its RHC designation several months before submitting its first bill as an RHC, and RHCs are required to use their RHC billing number within 12 months. Since WCCHS was grandfathered in under the cost-based reimbursement methodology, before a legislative change that significantly reduced the reimbursement rate for Medicare, the loss of the RHC billing number would have required WCCHS to reapply for the RHC program and receive reimbursement at the lower rate.

Our team brought the situation to the attention of WCCHS leaders, and they prioritized submitting a bill as an RHC within the allotted time. WCCHS was able to maintain its current RHC billing number and the higher reimbursement rate methodology, which created a much more favorable financial picture for the RHC.

Prior to the project with Stroudwater, the team at WCCHS had limited knowledge of the RHC designation requirements. After completion of the project, the WCCHS team is equipped with the knowledge and experience to work independently to complete the transition of the remaining practices.