Special Rules for Critical Access Hospitals Outpatient Billing
Previously, Critical Access Hospitals were being paid reasonable cost for outpatient services. The Drug Improvement and Modernization Act of 2003, section 405(e) amends the law to specify that payment to Critical Access Hospitals for outpatient services be made at 101 percent of the reasonable costs of those services.
The Drug Improvement and Modernization Act of 2003 was signed into law on December 8, 2003, allowing payment for outpatient Critical Access Hospitals services to be made at 101 percent of reasonable costs of those services, after application of deductible and coinsurance provisions. This policy was effective beginning on or after January 1, 2004.
Critical Access Hospitals may be paid using the standard payment method (i.e. cost-based payment with billing of the carrier for professional services) or the all-inclusive payment method (i.e. cost-based payment for facility services plus fee schedule payment for professional services). A Critical Access Hospital must notify WPS of an election of payment method, or change of a previous election, at least 30 days prior to the affected cost reporting period instead of 60 days as under the previous law. If no election is made, the Critical Access Hospital will be paid using the standard method.
If you have any questions regarding this issue, please contact the Audit Supervisor assigned to your facility. Refer to our Home Office Contacts page for names and phone numbers.
You can also find this information in our March 15, 2004 Medicare Newsletter.
Page Last Updated: Tuesday, 15-Jul-2008 10:35:53 CDT
