Critical Access Hospital (CAH) - JE Part A
Critical Access Hospital (CAH)
A Critical Access Hospital (CAH) is a hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-a-week emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CAH (fewer in some circumstances). The limited size and short stay length allowed to CAHs encourage a focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals. Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates.
Access the below CAH related information from this page.
- CAH Inpatient Billing Guide
- CAH MIPS Calculation Guide
- CAH Outpatient Billing Guide
- CAH Swing Bed Billing Chart
- Enrollment
- Inpatient Ancillary Services
- Method II Elections
- Nonphysician Practitioners
- Part A to B Rebilling Guidance
- PCIP DDE Claims Entry Screen to Report Rendering NPI
Resources
- CMS Critical Access Hospital Center
- CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 10, 20 and 70
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 8, Section 10, 20, 30, 40, 50 and 70
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.3 and 30
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220, 230 and 270
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 10.3, 50.3 and 60.4
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 10, 30, 40, 60, 100.2, 140 and 190
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20, 40, 240, 250, 260 and 290
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section 10, 20.1.1, 20.1.2 and 40.3.4
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 15, Section 10.1.1, 10.4 and 30.2.3
- CMS Change Request (CR) 8387 - Reassignment to Part A CAHs Billing under Method II
