Written by Corey Blackburn, DPM, Founder
Prairie Specialty Billing works with rural hospitals that need billing support without staffing a full revenue-cycle department. We can run the billing, or we can add accounts-receivable recovery, denial appeals, audits, claims support, and credentialing beside the team the hospital already has.
Billing for Rural Hospitals and Critical Access Hospitals
What is Method II billing for a critical access hospital?
Medicare lets a critical access hospital choose an optional outpatient method, often called Method II. Under the standard method, the hospital bills facility services and the clinician bills professional services. Under Method II, the hospital bills the professional service only when that clinician has reassigned billing rights to the hospital. If the reassignment is not on file, Medicare denies the hospital’s professional claim. Clinicians who do not reassign still bill their own professional services.
What is a swing bed?
A swing bed lets a critical access hospital use a bed for skilled care after the acute stay. The swing-bed claim is not a copy of the inpatient claim. The level of care, the dates, and the payer’s swing-bed rules have to match the bill.
How do rural health clinic and FQHC claims differ from a hospital outpatient claim?
Rural health clinics and federally qualified health centers are paid as encounters. An office-visit fee-schedule claim is the wrong model. The encounter, the practitioner, and what is included in that encounter have to match the clinic’s provider type.
Why this work does not fit a one-person business office
A small critical access hospital can have inpatient claims, outpatient claims, swing-bed claims, and a clinic at the same time. Those are different bills. Prairie can take the full cycle or a defined piece, such as older accounts receivable, denials, or credentialing, without replacing the people already on staff. The company is based in Grand Island, Nebraska, and works with providers in all 50 states.