3 Things Critical Access Hospital Admins Need To Know About Reimbursement

  • Healthcare Management
  • medical management
  • July 27, 2021

Read Time: 7 minutes Critical access hospitals provide primary, acute, and emergency services to rural areas. These 3 points will ensure these CAHs are reimbursed.

Everyone Deserves Care

About 20% of Americans live in rural areas. Like urban spaces, rural communities need access to high-quality healthcare. Unfortunately, many rural areas do not have crucial healthcare services, which can be life-threatening. A critical access hospital provides acute and emergency healthcare services to rural areas. These hospitals make up most of the medical services in these underserved areas.

viralmd connect 3 Things Critical Access Hospital Admins Need To Know About Reimbursement

The birth of the critical access hospital

Hospitals in rural areas continually struggle to be profitable. These hospitals often cannot provide advanced care and are at risk of closure. Almost 10% of rural hospitals closed in the last decade. However, in 1997, the Balanced Budget Act looked to stem the tide of closures. Institutions in rural areas were allowed additional reimbursements by converting to a CAH. In some states, Medicare covers 100% of the patient, plus an extra incentive to remain a CAH. The hospital must follow specific criteria to continue to receive payments in return. These 3 points are crucial for continued payouts.

1. Meeting key hospital criteria

A rural hospital can only benefit from reimbursements by adhering to specific requirements. These requirements help hospitals stay small to cover costs while better serving the community. For instance, CAHs are only allowed 25 or fewer inpatient beds. These hospitals must also provide 24-hour service with a nurse or LPN on duty. Hospitals must have at least 1 doctor on duty. Finally, the hospital should not be within 35 miles of another CAH.

2. A key hospital metric affects payments

Most hospitals look closely at length of stay or LOS. Length of stay is the period between admission and discharge. LOS is a crucial metric and will affect Medicare reimbursement. For acute patient care, LOS must average 96 hours or less. Therefore, hospitals must drive down the average length of stay for reimbursement.

3. It varies from state to state

States determine how critical access hospitals will receive reimbursement. Some states will have additional cost-related requirements. Others may have separate rules for inpatient, outpatient, and even telehealthcare. States may also have different needs based on demographic data. There are even states that do not provide CAH benefits. Hospital administrators must look closely at the requirements or risk losing out on significant payments.

Keep reimbursements top of mind

Critical access hospitals are vital for providing primary and emergency services to rural communities. These hospitals can benefit from reimbursements while serving the community. To keep hospitals running, administrators must continually review metrics and factors that affect payments.

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