Challenge

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.

Process

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:

  • Providing high-level overview training on RHC best practices to the WCCHS team
  • Establishing a regular meeting cadence to ensure proper focus on the project
  • Researching and answering specific questions from the WCCHS team
  • Identifying stand-alone physician practices eligible for RHC status
  • Assigning project champions and project managers to the project
  • Engaging various team members from operational, financial, and billing areas as needed
  • Educating WCCHS’s revenue cycle team, including an outsourced billing company, to ensure rural health claims were created and submitted successfully

Results

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

Qualitative Results

  • WCCHS was able to bill for RHC services at the initial RHC location
  • WCCHS received the appropriate payment for RHC services
  • Stroudwater and WCCHS developed an action plan to deploy for the remaining stand-alone physician practices

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.

“Amy and Zach’s knowledge and expertise complement each other very well, and what felt like an overwhelming project, wasn’t with their help,” said Katie Ksiezarczyk, CPC, CPB, Wyoming County Community Health System. “Having a knowledgeable and fun team to work with made for an enjoyable project and I truly enjoyed working with them.”