LTACH Reimbursement

As a PPS acute care hospital, reimbursement for physician services in an LTACH is identical to that of a PPS short-term acute hospital. The physician bills under Part B for Medicare patients or submits bills for commercial or managed care payers with the identical format as short-stay acute. The same physician fee is generated; the format and process for billing are the same. The physician must go through the LTACH credentialing process just as he or she would at any other facility.

Two Models for a Long-Term Acute Care Hospital

Currently, there are two models for long-term care hospital operation: the freestanding hospital and the hospital-within-a-hospital:

  • Freestanding Hospital Model

The Freestanding Model requires the LTACH to have its own building and be separate from the campus of another hospital.

As the label implies, Freestanding hospitals are self-contained hospitals located elsewhere and independently rather than in or on the campus of another hospital. The freestanding model requires the LTACH to have its own building and be separate from the campus of another hospital.

  • Hospital-within-a-Hospital Model

The Hospital-within-a-Hospital Model requires compliance with specific federal rules and regulations.

The hospital-within-a-hospital model requires compliance with specific federal rules and regulations, including issues of “control.” The hospital-within-a-hospital is separate and distinct from its host, but located on-site within leased space. Hospitals-within-hospitals typically purchase a number of services from the host, but the two entities must maintain the requisite degree of separateness.

For more information on how Murer Consultants can assist your organization in developing its own long-term acute care hospital, please contact us at 708-478-7030.