General Question for the Week of December 10, 2018

General Compliance Question of the Week


What is the Medicare policy when outpatient services are provided to inpatients of another facility? And which facilities does this policy apply?


Medicare beneficiaries may receive outpatient services at acute-care hospitals if they are patients at another facility, such as long-term-care (LTC) hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. Once the service has been furnished, the beneficiary returns to the other facility, such as the LTC hospital, to continue receiving care. Medicare pays the LTCH for all services, including the outpatient service, provided as part of its PPS rate. Medicare should not make a separate payment to the acute-care hospital for that outpatient service. Instead, the acute-care hospital, under arrangements with the LTCH, can look to the LTCH for payment for the outpatient service it provided to the LTCH inpatient.

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