RHC Decision Tool — Revival Health & Wellness Clinic

At a Glance — What You Gain vs. What You Give Up

✅ RHC Unlocks

Medicare AIR up to $165/visit (2026), rising to $190 by 2028 verified
Illinois Medicaid PPS encounter rate (cost-based, often exceeds standard FFS) clinic-specific
NHSC site application streamlined — HPSA re-verification waived verified
Permanent Medicare telehealth distant-site status for behavioral/mental health verified
Non-behavioral telehealth distant-site extended through 2028 verified
Medicare Advantage plans must pay ≥ traditional Medicare RHC rate not independently reverified
Productivity standards (visits/FTE) eliminated for 2025+ cost reports verified
Rigid "51% primary care hours" survey test eliminated verified
No requirement to prioritize Medicaid patients over commercial verified

⚠️ RHC Gives Up / Costs

340B drug pricing — not eligible as an independent RHC verified
Commercial insurance rates — completely unchanged by RHC status verified
Annual Medicare cost report — new recurring accounting obligation verified
Biennial program evaluation — mandatory verified
Annual emergency-preparedness exercise — mandatory verified
Cost-allocation burden: laser/IV/pellet/wellness services must be walled off from RHC billing principle verified, specifics vary
CMS survey + periodic re-survey cycle — ongoing compliance exposure verified
Accreditation + consultant fees — roughly $20K+ upfront (estimate) unverified estimate
6–12 month timeline before first RHC billing typical range

Full source-cited detail: rhc-certification-deep-research-2026-07-27.md and chart rhc-gains-vs-costs-chart-2026-07-27.png, both in the same research folder.

Is RHC the Right Move for Revival? Answer These to Find Out

This runs entirely in your browser — nothing is sent anywhere. Pull the numbers from AdvancedMD reporting where possible; estimates are fine.

1. What % of your total visits (last 12 months) were Medicare?

Check AdvancedMD payer-mix report. Estimate if needed.

2. What % of your total visits (last 12 months) were Illinois Medicaid?

3. What is your current average net reimbursement per visit, blended across Medicare + Medicaid only?

In dollars. If unknown, estimate conservatively (e.g. $85).

4. Roughly what does a primary-care visit cost you to deliver (staff time + allocated overhead), excluding cash/aesthetic services?

This determines your likely Medicare AIR — RHC pays the LESSER of your cost or the $165 (2026) cap.

5. What % of total practice revenue currently comes from cash-pay / aesthetic / wellness services (GLP-1, hormone pellets, IV/NAD+, laser)?

6. Do you have (or can you get) an accountant/consultant comfortable with RHC Medicare cost reports?

Yes, already have one Could find one No / unsure

7. How important is the 2027 NHSC site-approval plan to your overall strategy?

Critical Helpful, not essential Not a priority

8. Can you tolerate a 6–12 month runway and roughly $20K+ upfront cost before seeing any reimbursement benefit?

Yes, comfortably Tight, but possible No

0 = strong NO-GO | 100 = strong GO

Why this score:

Estimated annual Medicare/Medicaid AIR uplift (rough, illustrative only)

This tool is a decision-support aid, not financial, legal, or regulatory advice. Every figure it references (the $165/visit 2026 Medicare cap, the elimination of RHC productivity standards, the FQHC-vs-RHC sliding-fee distinction, etc.) is sourced and dated in the companion report rhc-certification-deep-research-2026-07-27.md. Confirm current numbers with your MAC, IL HFS, and an RHC-specialist consultant before committing funds.