How RHCs Should Be Reimbursed for Monoclonal Antibody Infusions

We have received several calls and e-mails in the last few weeks regarding monoclonal antibody infusions in the rural health clinic setting. Tommy Barnhart with the National Rural Health Association provided this breakdown of MA injection reimbursement.

Click here to view a CMS transmittal for freestanding RHCs issued 4/30/21 effective for cost reports ending after 3/31/2021. 

Among other things, it adds lines on Worksheet A specific to Covid vaccine administration (line 31.10) and monoclonal antibody (line 31.11) expenses and new columns on Worksheet B-1 to calculate reimbursement.  The calculation is similar to flu and pneumonia and reimbursed through the cost report in addition to the AIR.  For Covid and monoclonal antibody, this includes Medicare Advantage in addition to traditional Medicare.  As with flu and pneumonia, there is no method to bill the MAC for these services.  Hospital forms have not been adjusted yet but expect those to be done likewise soon.  FQHC forms have been updated similar to freestanding RHC. 

We will continue to work to improve the way that RHCs can bill for vaccine and monoclonal antibody infusions, especially during the critical time in our state’s healthcare system. Please contact us with any further questions.

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