Critical Access Hospital Billing For Supplies

[lizzi68]

I understand that if you are and inpatient in a CAH you are not billed for most supplies. I get this for routine stuff like soap, tooth brush/paste, comb, bandaid but, I gave a patient a doughnut for her bum and it is not chargable. Sterile 4x4s for dressing changes are not chargable and for some patients with bid wound changes, you use a lot of them. Just wondering if other CAH practice the same. I understand that CMS has regulations and our finance dept. says that the charges are built into the bed charge however, some patients need more "stuff" than others. We are always struggling financially. Just seems that other than routine items should be chargeable.

[OBERrural]

I know this is an old post, but I see there are no answers. We are quite the opposite. We are a 25 bed CAH and we charge for EVERYTHING. I was shocked since I came from a big city hospital where we didn't charge for anything.

[ershockerRN]

I am in nursing administration at a 25 bed CAH hospital. The reason you can't charge for most items is because of CMS with CAH is a costplus reimbursement of 101%.

If you can buy the item over the counter such as a medical supply store then you can't bill the patient for it. Most of the nursing staff may not know this because our charge sheet is built all in to one to prevent confusion of what is and what is not billable. The billers and coders have a list of billable items.

CAH hospitals survive off of Medicare patients. Your total percentage of Medicare patients for the year. So in theory and the best way to understand CAH hospitals reimbursement is: if a CAH only saw 1 Medicare patient a year with no other patients ever in the hospital; they would have a 100% Medicare percentage. So whatever it cost to operate the hospital for that year with a full staff and all equipment would be reimbursed 101%.

Most good operating CAH can stay in the black with a 55-60% Medicare percentage. That's the only way for rural hospitals to survive.

[CraigB-RN, MSN, RN]

There is always confusion about that. And unfortunately most nursing staff working at CAHs don't really understand the system. Then again a lot of administrators don't.