Patient transfer from ED to Inpatient class

We are a CAH in Wisconsin. When a patient is seen in our ED and then an inpatient order is written and the patient is then transferred to our CAH (we use Epic) this is considered all one encounter. But when it comes to coding and billing, we separate (somewhat manually) the charges onto separate bill types (create a related outpatient HAR). We send all the ED/OP charges on an outpatient bill and all the Inpatient charges on the inpatient bill. Is this what other CAH's do? I spent 15 years at an OPPS hospital so I'm not used to this type of billing. I would think this would cause a patients insurance to use outpatient benefits and inpatient benefits for the same stay. I'm just wondering if this is just common practice? Thank you


  • We require discharge and readmission so that it is two separate encounters. Separate outpatient and inpatient claims is a Medicare CAH requirement. For some non-Medicare insurances (that require this), we then have to combine into one encounter for one claim, but it is much easier to combine than separate.

  • Yeah, as I learned about CAHs, I was amazed that CMS lets this be billed with two claims, with the resultant higher payment due from patients. But that's the rule, and maybe beneift of being a CAH depending on your view.

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