Association for Rural & Community Health Professional Coding

10/03/2025

Our website (archprocoding.com) and email are temporarily down. We’re working hard to get everything back online as quickly as possible.

Thank you for your patience, we’ll keep you posted here with updates!

ARCHPRO Coding and Consulting

10/01/2025

CMS Edit Preventing Reimbursement to RHCs for SNF Services

Dear RHC Community,

A billing issue introduced by a July 1st CMS quarterly edit to the Fiscal Intermediary Shared System (FISS), has caused widespread denials, rejections, and recoupments of RHC Skilled Nursing Facility (SNF) claims.

Impacting CPT codes 99304 through 99309, NARHC estimates that this edit is thwarting the proper adjudication of over 92,000 RHC claims per month. In terms of financial impact, our calculations are that this edit has caused approximately $20 million of Medicare reimbursement per month to be erroneously withheld from Rural Health Clinics.

Through our discussion forum, NARHC was able to gather evidence of the issue and bring it to the attention of CMS in early September. After a period of time, CMS asked NARHC for additional evidence of this issue, and we promptly provided more claims denial and recoupment examples. While CMS staff has indicated to us that they are researching the problem, as of the time of writing, the only public acknowledgement we have from either CMS or the MACs of this issue is an alert from WPS that they reported it to the FISS for investigation.

NARHC is committed to getting this issue resolved as fast as possible. Updates will be shared on our discussion forum as soon as we have them, and we will send out an email on this listserv once a definitive resolution has been identified.

Given the substantial volume of claims impacted, resolving this issue is a top priority for NARHC and we will work diligently to elevate the issue to CMS leadership and other policymakers as appropriate.

NARHC REF Lookup Tool Portal: https://rhcdata.org/data/

System Status & Alerts: https://www.wpsgha.com/alerts/89

Sincerely,

Nathan Baugh
Executive Director
National Association of Rural Health Clinics

09/18/2025

Information for Critical Access Hospitals

The critical access hospital (CAH) bills for facility and professional outpatient services only when physicians or practitioners reassign their billing rights to the CAH.

Learn how CAHs can prevent Fiscal Intermediary Shared System (FISS) reason codes 31006 and 31007 (indicating that providers don’t have a reassignment on file in PECOS) claim denials:

• CAHs must submit the reassignment application through PECOS or the paper Form CMS-855I

• Starting in January 2026, we’ll deny CAH claims for professional services if a reassignment isn’t in PECOS

More Information:

• Information for Critical Access Hospitals:https://www.cms.gov/files/document/mln006400-information-critical-access-hospitals.pdf

• Editing for Duplicate Processing for Practitioner Professional Services and CAH Professional Services (PDF)https://www.cms.gov/files/document/r13041otn.pdf Medicare Administrative Contractor instruction

• Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Serviceshttps://oig.hhs.gov/oas/reports/region6/62105003.pdf Office of the Inspector General report

09/17/2025

FREE 2026 ICD-10 Webinar for Current Members on September 30, 2026 • $29.99 for Non-Members

https://mailchi.mp/archprocoding.com/50-off-to-celebrate-our-new-look-20258761

09/11/2025

🚨 CY 2026 CMS PFS PROPOSED RULE – IMPACTS ON RHC/FQHC DOCUMENTATION, CODING & BILLING

CMS’s CY 2026 Physician Fee Schedule proposed rule introduces important updates that will directly affect Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

Key highlights include:
🔹 Behavioral Health Integration / CoCM billing changes — G0512 will be discontinued in 2026, requiring use of individual CPT codes. Certain BHI/CoCM codes may also now count as primary care services for ACO attribution.
🔹 Telehealth & CBTS updates — G2025 extended through 12/31/26, G0071 eliminated, and CMS is seeking comment on possibly letting telehealth generate AIR/PPS payment in 2027.
🔹 Virtual direct supervision — permanently allowed via real-time audio/video (not audio-only).

➡️ These changes bring both new opportunities and challenges for clinical providers, facility leaders, and revenue cycle staff. Preparing now will reduce compliance risk and strengthen workflows.

📖 Full details (with proposals, practical notes, and challenges) are in the comment pinned below.

Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1832-P)On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Sch...

08/19/2025

3 Days Remaining - 50% off all certification classes for a limited time with promo code: NEWLOOK50 Expires 8/22/2025
https://mailchi.mp/archprocoding.com/50-off-to-celebrate-our-new-look-20258697

08/12/2025

Celebrate our new brand! Get 50% off all certification classes for a limited time with promo code: NEWLOOK50 Expires 8/22/2025
https://mailchi.mp/archp.../50-off-to-celebrate-our-new-look

08/05/2025

Celebrate our new brand! Get 50% off all certification classes for a limited time with promo code: NEWLOOK50 Expires 8/22/2025

https://mailchi.mp/archprocoding.com/50-off-to-celebrate-our-new-look

08/02/2025

One week away!

Share and register for the Healthcare Provider Billing & Coding Workshop, presented by the Association for Rural & Community Health Professional Coding.

This hands-on training is specially designed for MDs, DOs, PAs, and NPs, with a focus on improving documentation and billing outcomes.

August 8 | Soaring Eagle Casino & Resort | 1–4 PM | 3 CME Credits | Just $25

🔗Registration Closes on August 7: https://mcrh.msu.edu/News-and-Events/Events/2025/08/provider-billing-coding

07/16/2025

Register Now!

Healthcare Provider Billing & Coding Workshop, presented by the Association for Rural & Community Health Professional Coding.

This hands-on training is specially designed for MDs, DOs, PAs, and NPs, with a focus on improving documentation and billing outcomes.

August 8 | Soaring Eagle Casino & Resort | 1–4 PM | 3 CME Credits | Just $25

🔗Register now: https://mcrh.msu.edu/News-and-Events/Events/2025/08/provider-billing-coding

07/15/2025

🎉 We’ve had a glow-up!
After a decade of dedication to rural and community health education, ArchProCoding has a bold new look—and a brand-new website to match!

👀 Check it out here: www.ArchProCoding.com

We’re still the same team you trust—just sleeker, faster, and more user-friendly. And as with any new launch, we might hit a few bumps—so thank you for your patience as we smooth everything out!

05/07/2025

ArchProCoding would like to say a big thank you to Melissa Lackey, Jana Harrison, Amy Felan, Lurel De Bra and Justin Perkins with Texas A&M Health Rural Engagement Program for hosting a CAH and RHC coding and billing bootcamp class. Thank you for all of your help putting these classes together and obviously helping to PACK THE HOUSE.

ArchProCoding and Texas A&M would also like to thank Uvalde Memorial Hospital for providing the space for us to hold the classes. We look forward to coming back soon.