CMS issued further guidance yesterday on Hospital Inpatient Admission Order and Certifications. Particularly, CMS clarified certain aspects of the 96 Hour certification requirement for Critical Access Hospitals (CAH). Of particular interest, CMS stated in this guidance:

If a physician certifies in good faith that an individual may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the CAH and something unforeseen occurs that causes the individual to stay longer at the CAH, there
would not be a problem with regards to the CAH designation as long as that individual’s stay does not cause the CAH to exceed its 96-hour annual average condition of participation requirement. However, if a physician cannot in good faith certify that an individual may reasonably be expected to be discharged or transferred within 96 hours after admission to the CAH, the CAH will not receive Medicare reimbursement for any portion of that individual’s inpatient stay.

This answers the question as to what happens with stays that exceed 96 hours that are unexpected. However, this guidance does nothing to help CAH’s that have developed service lines that treat higher acuity patients and places these facilities at risk for the cost of the entire hospital stay per the last sentence.