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Rural Emergency Hospital (REH) - JF Part A

Rural Emergency Hospital (REH)

A rural emergency hospital (REH) is an entity that operates for the purpose of providing emergency department services, observation care, and other outpatient medical and health services specified by the Secretary in which the annual per-patient average length of stay does not exceed 24 hours. The time calculation for determining the length of stay of a patient receiving REH services begins with the registration, check-in, or triage of the patient (whichever comes first) and ends with the discharge of the patient from the REH. The discharge occurs either when the physician or other appropriate clinician has signed the discharge order, or at the time the outpatient service is completed and documented in the medical record. The entity must not provide inpatient services, except those furnished in a licensed distinct-part unit of a skilled nursing facility to furnish post-hospital extended care services.

REH services are covered outpatient department (OPD) services, excluding services described in section 1833(t)(1)(B)(ii), furnished by an REH that would be paid under the Outpatient Prospective Payment System (OPPS) when provided in a hospital paid under the OPPS for outpatient services, provided such services are furnished consistent with the conditions of participation at 42 C.F.R. §§ 485.510 - 485.544.

All institutional REHs billing Medicare will be required to enroll with Medicare as REHs and submit claims to the Part A Medicare Administrative Contractor using an institutional claim form.

Payment for REH Services

Starting on January 1, 2023, an REH that provides rural emergency hospital services (as defined in section 1861(kkk)(1) of the Act) will receive Medicare payment for those services pursuant to section 1834(x)(1) of the Act that reflects a 5 percent increase over the payment rate the provider would otherwise receive through the hospital outpatient prospective payment system (OPPS). Any co-payments for these services will be calculated based on the standard OPPS rate for the service, excluding the 5 percent payment increase.

Example:

  1. Service/Rate x 0.05 = Increase Amount for REH Services

    $100.00/Rate x 0.05 = $5.00 Increase Amount for REH Services
     
  2. Service/Rate + Increase Amount for REH Services = Allowed Amount

    $100.00 + $5.00 = $105.00 Allowed Amount
     
  3. Service/Rate x 0.20 = Coinsurance

    $100.00 * 0.20 = $20.00 Coinsurance

Claims for REH services are paid based on OPPS prospective rates and are adjudicated based on OPPS payment policies and rules. Services performed by an REH that do not meet the definition of an REH service (i.e., certain outpatient services that may be provided on an outpatient basis by OPPS hospitals but are not paid under the OPPS) are paid at the same rate as the service would be paid if performed at an OPPS hospital and paid based on the applicable fee schedule of the OPPS. Such services are not considered REH services and do not receive the additional 5 percent payment that REH services receive. Ambulance services furnished by an entity owned and operated by an REH paid under the ambulance fee schedule as described at section 1834(l) of the Act. Post-hospital extended care services furnished by an REH that has a unit that is a licensed distinct-part unit of a skilled nursing facility are paid under the skilled nursing facility prospective payment system described at section 1888(e) of the Act.

In addition to payment for the individual claims, section 1834(x)(2) of the Act requires REHs to be paid a monthly facility payment. The monthly facility payment for every REH is the same. There is no adjustment to the facility payment due to the size of the REH or amount of revenue generated by the REH. For 2024 and subsequent years, this payment will be updated annually by the hospital market basket percentage increase.

Claims submitted with the provider type “Other” option selected, specifying “Rural Emergency Hospital” until the forms are updated with the new provider type are accepted.

Requirement Description
Unique Identifying Provider Number Ranges 3rd - 6th digits
  • 0001-0879
Type of Bill (TOB)
  • 013X, 014X
Payment CMS will send the value for the facility payment that is being applied monthly for all REH providers. Monthly payment is made on the last day of the month and updated annually. The monthly facility payment information will populate on the Remittance advice summary screen (MAP 07959).

Noridian will calculate payment for covered services not processed by the OPPS Pricer with a Status Indicator (SI) of G or K with a 5% payment increase for the REH providers identified with provider type “24”. Services paid at reasonable cost (SI = F or L) do not receive the 5% payment increase.

Noridian will separately capture the 5% payment increase for the REH providers and report the increase for items not paid with the OPPS Pricer on the electronic remittance advice (ERA) for balancing purposes as follows:

Group Code: CO
CARC: 172

 

Resources

 

Last Updated Thu, 05 Jan 2023 18:25:49 +0000