Hospital - General - JE Part A
Hospital - General
On this page, view the below information.
- Acute Care
- Long Term
- Short Term
- Specialty Hospital (Cardiac, Orthopedic, or Surgical)
- Children's Hospital
- Subunits: Swing-bed, Psychiatric, and Rehabilitation Units
- Application Requirements
- Application Time Frame
Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10, Section 10.2.1.8 and the CMS IOM, Publication 100-07, State Operations Manual, Chapter 2.
A hospital is a health care institution, providing patient treatment with specialized medical and nursing staff and medical equipment
- Inpatient hospital services are defined in Title XVIII of the Social Security Act (the Act) and in the regulations (42 CFR 409.10)
- Term "inpatient hospital or inpatient Critical Access Hospital (CAH) services"- means the following services furnished to an inpatient of a participating hospital or of a participating CAH, or to an inpatient of a qualified emergency services or foreign hospital
- Bed and board
- Nursing services and other related services
- Use of hospital or CAH facilities
- Medical social services
- Drugs, biologicals, supplies, appliances, and equipment
- Certain other diagnostic or therapeutic services
- Medical or surgical services provided by certain interns or residents-in training
- Transportation services, including transport by ambulance
- Billing for Acute Care
- For more information regarding billing, go to the billing portion of the website
Acute Care
- Acute care is a branch of health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery
- Care for acute health conditions is the opposite from chronic care, or longer-term care
- Acute care services are generally delivered by teams of health care professionals from a range of medical and surgical specialties
- Acute care may require a stay in the following:
- Hospital emergency department
- Ambulatory surgery center
- Urgent care center
- Other short-term stay facility, along with the assistance of diagnostic services, surgery, or follow-up outpatient care in the community
- Hospital-based acute inpatient care typically has the goal of discharging patients as soon as they are deemed healthy and stable.
- Acute care settings include but are not limited to:
- Emergency department
- Intensive care
- Coronary care
- Cardiology
- Neonatal intensive care
- Billing for Acute Care
- For more information regarding billing, go to the billing portion of the website.
Long-Term
- Long-term care is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods
- Long term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time
- Long-term care is certified as acute care hospitals, but focus on patients who, on average stay more than 25 days
- Most of the patients are transferred from intensive or critical care units
- They Specialize in treating patients who may have more than one serious condition but may improve with time.
- Long-term hospitals do get paid differently, if questioned refer to the Provider Call Center Part A
- Billing for Long Term
- For more information regarding billing, go to the billing portion of the website.
Short-Term
- These services last several weeks or a few months while the patient is recovering from a sudden illness, injury or surgery from which they are expected to recover
Specialty Hospital (Cardiac, Orthopedic, or Surgical)
- A hospital that provides a limited range of services (e.g., orthopedic surgery, ophthalmology, or obstetrics)
- Two thirds of Medicare patients receive care for just two Diagnosis-Related Groups (DRGs) and outpatient surgical procedures
Children's Hospital
- A children's hospital is a hospital which offers its services exclusively to children
- The hospital will only be enrolled if the child qualifies for Medicare
- Falls under the Tax Equity and Fiscal Responsibility Act (TEFRA) - meaning they do not require a prospective payment system (PPS) effective date on their enrollment
- This type of group does not accurately account for the resource costs for the types of patients treated in this facility
Subunits: Swing-bed, Psychiatric, and Rehabilitation Units
- While these units receive a State survey, a separate provider agreement is not required
- Hospital's provider agreement incorporates these units
- Submit 855A change application to add the swing bed unit as a practice location via paper
- Submit 855A initial application to add the swing bed unit as a practice location via PECOS
- Approved by CMS to furnish post-hospital skilled nursing facility (SNF) services
- Hospital or CAH patients' beds can "swing" from furnishing hospital services to providing SNF care without the patient necessarily being moved to another part of the building
- As stated in 42 CFR §482.66, to obtain swing-bed status the hospital must
- Have a Medicare provider agreement
- Be in a rural area
- Have fewer than 100 non-newborn or intensive care beds
- Billing for Sub-units
- For more information regarding billing, go to the billing portion of the website.
Application Requirements
Application | Tips |
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PECOS application |
|
CMS-855A |
|
CMS-588 EFT |
|
Application Time Frame
Application Type | Processing Time |
---|---|
PECOS | On average, it can take 15 to 50 calendar days before application is sent to state and CMS for approval |
Paper | On average, it can take 30 to 65 calendar days before application is sent to state and CMS for approval |
Note:
- Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the State Agency and CMS. There is no set timeframe for their review.
- Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.