Critical Access Hospitals Center

Spotlights

• Information for Critical Access Hospitals

  The critical access hospital (CAH) bills for facility and professional outpatient services only when physicians or practitioners reassign their billing rights to the CAH. 

  Learn how CAHs can prevent Fiscal Intermediary Shared System (FISS) reason codes 31006 and 31007 (indicating that providers don’t have a reassignment on file in the Provider Enrollment, Chain, and Ownership System (PECOS)) claim denials:

  • CAHs must submit the reassignment application through PECOS or the paper Form CMS-855I
  • Starting in January 2026, we’ll deny CAH claims for professional services if a reassignment isn’t in PECOS

  More Information:

  • Information for Critical Access Hospitals (PDF) booklet revised to add reassignment information

    Editing for Duplicate Processing for Practitioner Professional Services and CAH Professional Services (PDF) Medicare Administrative Contractor instruction

    Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services Office of the Inspector General report

     

• Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions (PDF)
  On August 19, 2013, in the FY2014 IPPS/LTCH final rule CMS clarified and revised the conditions of payment for hospital inpatient services under Medicare Part A related to patient status. On September 5, 2013, CMS released guidance (PDF) that discussed the provisions of the final rule regarding the physician order and physician certification of hospital inpatient services. This document includes further clarification of issues addressed in the previous guidance.