Critical Access Hospitals: Bill Correctly

The Information for Critical Access Hospitals (PDF) (CAH) booklet explains how to properly document and bill for services, including:

• Bed and board, nursing, and other related services
• Facilities
• Medical social services
• Drugs
• Biologicals
• Supplies, appliances, and equipment for inpatient hospital care and treatment

An Office of Inspector General report found that Medicare improperly paid CAHs and health care professionals for the same CAH services. A CAH can only bill for facility and professional outpatient services if the physician or practitioner reassigns their billing rights to them.

Physicians or practitioners providing professional outpatient CAH services can either:

• Reassign their billing rights to the CAH and agree to the optional payment method. They must attest that they won’t bill for these services.
• File Medicare Administrative Contractor claims for these services under the Medicare Physician Fee Schedule.

More Information:

• Section 250 Medicare Claims Processing Manual, Chapter 4 (PDF)
• Medicare Payment Systems educational tool
• Critical Access Hospitals Center webpage