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PAYMENT ADJUSTMENT YEAR 2019 MEDICARE EHR INCENTIVE PROGRAM CRITICAL ACCESS HOSPITAL RECONSIDERATION

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The document outlines the process for Critical Access Hospitals to apply for reconsideration of the 2018 Medicare EHR payment adjustment if they believe the adjustment was made in error. It includes application submission guidelines, deadlines, required information, and certification statements. The application must be submitted electronically or via fax by March 6, 2020, and is only valid for 2018 adjustments.

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How are hospitals reimbursed under Medicare?

Hospitals are reimbursed through Medicare Part A for Medicare-related capital costs (e.g., depreciation, interest, rent, and property-related insurance and taxes costs). New hospitals are paid on a cost basis for their first 2 years of operation.

How does critical access hospital reimbursement work?

We pay for CAH outpatient facility services at 101% of reasonable costs as section 1834(g)(1) of the Social Security Act requires. We pay CAHs under the standard payment method unless they elect the optional payment method.

What is a downward payment adjustment?

A downward payment adjustment will apply to CAHs that were not. meaningful users of CEHRT, did not meet the minimum score of 60 points, or failed to report electronic clinical quality measure (eCQM) data as required. CAHs may apply for a Hardship Exception if compliance would result in. significant hardship.

Who funds critical access hospitals?

CAHs are limited to 25 beds and primarily operate in rural areas. Unlike traditional hospitals (which are paid under prospective payment systems), Medicare pays CAHs based on each hospitals reported costs. Most CAH beds are swing beds, in which beneficiaries can receive acute or post-acute care.

How does Medicare reimburse critical access hospitals?

However, CAH payments are based on each CAHs costs and the share of those costs that are allocated to Medicare patients. CAHs receive cost based reimbursement for inpatient and outpatient services provided to Medicare patients (and Medicaid patients depending on policy of the state in which they are located).

Are critical access hospitals paid by DRG?

Medicare reimburses CAHs based on each hospitals costs not on a calculated MS-DRG payment. Most critical access hospitals (both inpatient and outpatient care) are paid at 101 percent of reasonable costs. CAHs are reimbursed for inpatient, outpatient, laboratory, therapy services and post-acute care in swing beds.

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