Below is a list of documentation that must be completed for the Medicare Rural Health Clinic (RHC) Re-Survey. Please mail completed documentation to AAAASF at P.O. BOX 9500, Gurnee, IL 60031 or fax to 847-775-1985. You may also scan and email to firstname.lastname@example.org.
- A copy of each mid-level clinician and physician State Medical License
- AAAASF Medicare Rural Health Clinic (RHC) Accreditation Agreement
- 30-day Staff Schedule
- Authorization to Release Information Form signed by each mid-level provider and clinician on staff
- Facility Identification Form
- Staff Identification Form
- Facility Director's Attestation Form
Once all of the required documentation is received in the AAAASF office, it will be reviewed within 10 business days. You will be contacted if additional paperwork is needed. Otherwise, you will receive a request to submit your facility’s hours of operation and blackout dates so that a survey can be scheduled. An email confirmation will be sent to you once the survey has been arranged.
AAAASF is required to conduct Validation Surveys on 5% of all Medicare Accredited Rural Health Clinics (RHC) each year. As a Medicare provider, both the CMS State and AAAASF Central Office reserve the right to conduct an unannounced Validation Survey at any time during the certification process.
Please review the Standards and Checklist Manual carefully before submitting the completed documentation to AAAASF.