| Site | Op. hrs/wk | Covered hrs | Coverage | Status |
|---|---|---|---|---|
| Red Fox RHC | 40.0 | 37.0 | 92.5% | PASS |
| Lincoln Co. | — | — | — | PRE-LAUNCH |
| Garrard Co. | — | — | — | PRE-LAUNCH |
| Input | Source | Status |
|---|---|---|
| Provider hours by role | Platform schedules + sign-in | AUTO |
| Encounter counts by payer | athenaOne claim feed | AUTO |
| Facility + overhead costs | GL import, monthly | AUTO |
| Allocated LC shared services | Cost allocation model | DESIGN |
| CPT | Test | Medicare | KY Medicaid |
|---|---|---|---|
| 87880 | Rapid strep | $16.55 | $15.30 |
| 87804 | Rapid flu | $16.55 | $15.30 |
| 81001 | Urinalysis w/ micro | $3.17 | $2.93 |
| 82947 | Glucose, blood | $4.42 | $4.09 |
| 36415 | Venipuncture | $3.00 | $3.00 |
A hub-and-spoke rural health network run from one console: rural clinic sites staffed by on-site APPs, backed by the Lexington Clinic physician pool over synchronous video, with billing routed so every encounter is paid correctly.
Red Fox RHC in Knott County is the live pilot. Lincoln and Garrard counties are onboarding, Clark County is in the pipeline, and the architecture is designed to scale toward roughly 100 rural sites. Each site runs as its own certified Rural Health Clinic with its own CCN and subpart NPI inside a single athenaOne tenant, while queueing, physician assignment, compliance evidence, and network analytics are shared services operated centrally.
The core economic idea: the encounter happens in the clinic, furnished by the on-site APP, with an LC physician joining as a consultant by video. That keeps every qualifying visit billable at the RHC All-Inclusive Rate on a UB-04 with the CG modifier, while labs, the imaging technical component, and chronic care management stack on top as separate CMS-1500 revenue.
Six tabs, four audiences. Everyone works the same encounter from a different angle.
| Tab | Who uses it | What it does |
|---|---|---|
| Network Ops | Rural Health Division leadership | Portfolio view: site status and onboarding milestones, live 50% rule coverage per site, the mobile imaging rotation, and CMS-222 cost report data capture. |
| Practice Manager | Central PM pool | The operational heart. Watch every site's virtual queue, match waiting patients to available LC physicians, monitor active consults, and flag patients back to the on-site APP. |
| Patient Check-In | Front desk and kiosk at the rural site | Registers the patient into the virtual queue: demographics, payer (Medicare, the KY Medicaid MCOs, commercial, self-pay), reason for visit, urgency, and the telehealth consent that the compliance engine requires before queueing. |
| Active Visit | On-site APP and consulting LC physician | The consult itself: Doxy.me video under a BAA, an audio-only fallback that demands a logged reason, APP-owned documentation, point-of-care lab orders, and referrals into the LC hub. |
| Billing & Compliance | Revenue cycle and compliance | The rulebook rendered live: the AIR rate display, split-billing configuration checks, subpart NPI and enrollment guardrails, and the in-house lab fee reference. |
| Guide | Everyone | This document, the glossary, the FAQ, the guided tour, and Roxi. |
The site selector in the header scopes the console. Onboarding sites stay locked until go-live; pipeline sites show assessment status only.
From the waiting room in Knott County to a clean claim, one encounter takes seven steps. The platform enforces the order.
One encounter, two claim forms, and a rate cliff the workflow is built to avoid.
Every qualifying RHC visit bills on a UB-04 institutional claim tied to the site's CCN, with the CG modifier on the qualifying visit line. Payment is the All-Inclusive Rate: cost-based, paid at the lesser of the site's cost per visit or the statutory cap, currently modeled at $152 and up with annual escalation. The billing provider is the on-site APP, always. The consulting LC physician appears in the record as a consultant, never as the billing provider.
The AIR does not bundle everything, and that is the point. Four revenue lines bill separately at fee-schedule rates on CMS-1500:
| Line | Fee basis | Notes |
|---|---|---|
| In-house CLIA-waived labs | CLFS | Strep 87880 and flu 87804 at $16.55, urinalysis 81001 at $3.17, glucose 82947 at $4.42, venipuncture 36415 at $3.00 (Medicare; KY Medicaid tracks CLFS at roughly 92 to 95%). |
| Imaging technical component | PFS | The mobile unit bills the TC at the fee schedule on its rotation day. The professional component is read remotely by LC Radiology via PACS and billed with modifier 26. |
| Chronic care management | PFS | Recurring monthly revenue. The platform tracks the enrolled panel and monthly time thresholds. |
| Send-outs and referrals | LC fee schedules | Send-out labs, specialty visits, and advanced imaging route to the Lexington Clinic hub: downstream capture rather than leakage. |
Four controls run as live software checks, not annual scrambles.
An NP, PA, CNM, CP, or CSW must be on-site and seeing patients at least 50% of the clinic's operating hours. CMS verifies through schedules and sign-in logs, and it is the most-cited RHC deficiency nationally. The platform computes coverage continuously from schedules and sign-ins (Red Fox currently runs 37.0 of 40.0 hours, 92.5%) and exports a survey-ready evidence pack of schedules, sign-in logs, and session records on demand.
Each site's subpart NPI must stay isolated in every system it touches: the athenaOne department, the clearinghouse, and payer portals, all validated against the IT configuration checklist before the first claim. Commingling NPIs is the top cause of incorrect AIR attribution and MAC audits.
AIR telehealth participation requires synchronous audio-video. The Active Visit workspace treats audio-only as an exception that demands a logged reason (no device, insufficient bandwidth, patient declines), written to the immutable session record.
When LC acquires a site through a change of ownership and accepts Medicare assignment, it inherits the site's full Medicare history, overpayments included. A pre-close overpayment audit is a gating item for every acquisition, alongside the CMS-855A filing.
A new county goes from letter of intent to live in roughly ten months. Lincoln County is at M3; Garrard is at M1.
| Phase | Months | What happens |
|---|---|---|
| Assess | Pre-M0 | Market assessment, HPSA or MUA designation check, candidate clinic identified. A site stays pipeline (like Clark County) until designation is confirmed. |
| Commit | M0 to M1 | LOI signed, feasibility and entity review, site survey scheduled, APP recruiting opens. |
| File & contract | M1 to M3 | CHOW filed on CMS-855A, pre-close overpayment audit, provider credentialing, MCO contracting with the KY Medicaid plans. |
| Build | M3 to M7 | athenaOne department configured, subpart NPI isolation validated on the IT checklist, bandwidth assessment and remediation, mobile imaging rotation slotted, APP hiring completed. |
| Prove | M7 to M9 | End-to-end claim testing completes at least 30 days before the Tie-In Notice. No billing sign-off, no go-live. Staff train on the queue, consult, and documentation workflows. |
| Go live | M9 to M10 | Tie-In Notice lands (target M9), the site unlocks in the console, first patients queue, and 50% rule capture starts on day one. |
The AIR is cost-based, so the cost report (Form CMS-222) is a revenue document. The platform feeds it continuously instead of reconstructing it at year-end.
Three inputs flow automatically: provider hours by role from platform schedules and sign-ins, encounter counts by payer from the athenaOne claim feed, and facility and overhead costs from a monthly GL import. The fourth, allocated LC shared services, is in design as a cost allocation model.
Network analytics watches the AIR trend per site against the cost feed, so cost-per-visit surprises show up in-quarter, not at settlement. The same telemetry powers the 50% rule table and the evidence pack export.
Roxi is this platform's resident expert, the Rural Health Division's sibling to Lexi on lexingtonclinic.com. She knows every workspace, every billing rule, this guide, the glossary, and the tour.
Open her from the Ask Roxi launcher at the bottom right, from any glossary popover, or from the buttons scattered through this guide. She answers questions, runs quick numbers (try revenue for 20 visits a day or what if the APP covers 18 of 40 hours), looks up lab fees by CPT or by name, and can navigate for you: ask her to open a tab, jump to a guide section, or start the tour.
? opens this guide from anywhere. Esc closes Roxi, popovers, and the tour. Dotted-underlined terms are tappable definitions; hover any header control for a micro-tip.
Roxi ships self-contained: her knowledge base lives in this file and she answers locally with zero backend, so the page works from a laptop, a kiosk, or Cloudflare Pages as-is. To upgrade her to a model-backed assistant, point window.ROXI_CONFIG.gatewayUrl at a Worker that speaks the Lexi gateway contract (same request and response shape as the lexingtonclinic.com widget) and she will use it, falling back to local answers if the gateway is unreachable. The button below exports her full knowledge pack formatted as a system prompt for that Worker.
Every term that appears dotted-underlined in the console, in one place. Tap any card to ask Roxi for more.