Critical access hospitals, rural emergency hospitals, and other rural facilities should all take note of updated CMS guidelines.
As we know, it is essential for revenue cycle leaders to remain informed and compliant with the ever-changing CMS guidelines to ensure efficient reimbursement processes.
That being said, CMS recently released guidance on the proper billing practices, designations, and conversion processes for critical access hospitals (CAH) and rural emergency hospitals (REH). Remaining compliant with these designation and conversion processes will ensure your organization is getting the reimbursement it deserves.
Medicare-participating hospitals must meet several conditions to become and remain a CAH. CMS updated the location requirement for CAHs, specifying that they must be more than a 35-mile drive on primary roads from any other CAH or hospital.
A primary road is a numbered federal or state highway with two or more lanes each way, according to the guidance. CAHs in areas with only secondary roads available or mountainous terrain must be a 15-mile drive from other hospitals.
To establish a process for overseeing and resolving patient grievances, CAHs are now required to inform each patient of their rights before starting or ending care. In addition, CAHs must now have a unified and integrated quality assessment and performance improvement program if they are part of a multi-hospital health system.
The updated guidance also detailed the optional payment method for CAHs. “Under the optional payment method, the CAH bills facility and professional outpatient services only when physicians or practitioners have reassigned their billing rights to them,” said CMS. After physicians and practitioners reassign their billing rights to a CAH, they can’t bill for professional services.
CMS also included information on its newest provider type, REH. “REHs allow for emergency services, observation care, and additional medical and health outpatient services (if the REH elects to provide them) that don’t exceed an annual per-patient average of 24 hours,” said CMS.
REHs generally convert from a CAH or rural hospital with no more than 50 beds and don’t provide acute inpatient services, according to CMS.
Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.
CMS recently released guidance on the proper billing practices, designations, and conversion processes for critical access hospitals and rural emergency hospitals.
Remaining compliant with these designation and conversion processes will ensure your organization is getting the reimbursement it deserves.