Class 1 Hospital Services

8/14/2019 Class 1 Hospital Services

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Hospital Services



Introduction

The decision to admit is based oncomplex medical judgment

Must be substantiated by aphysician’s order



May be based on Severity of the patient’s signs and symptoms

Medical predictability of something adversehappening to the patient

Need for diagnostic studies that appropriatelyare outpatient services to assist in determiningwhether the patient should be admitted

Availability of diagnostic procedures at the timewhen and at the location where the patientpresents



Medical Services

Medical services are those servicesprovided to patients who do notrequired surgery to correct orenhance body functions

Are commonly subdivided accordingto hospital needs for such specific

services



Surgical Services

General surgery consists of surgeries to correct conditions invarious body systems

These services are generallysubdivided based on the bodysystems e.g. cardiothoracic,

gastrointestinal, plastic surgery etc.



Rehabilitation Services

Rehabilitation hospitals or hospitalunits focus in restoring patientfunction

Inpatient rehab. facilities are knownas IRF

Medicare regulates services which

must have substantiateddocumentation to be medicallynecessary and reasonably used



Psychiatric Services

Inpatient psychiatric services (IPF)may be independent or freestanding or a unit within the acutecare facility

Medicare reimburses these facilitiesonly for active treatment that

improves patients condition



Psychiatric Services

Three criteria must be addressed inIPF patients documentation Individualized treatment or diagnostic

plan

Services expected to improve thecondition or for purpose of diagnosis

Services supervised and evaluated by aphysician



Ancillary Services

Ancillary services typically includedin an inpatient setting are: nursing,radiology, laboratory, physical andoccupational therapy, respiratorytherapy, dietary counseling, socialservices, case management etc.



Inpatient Accommodations

We can usually expect a private or semi-private room, when needed specialtyunits such as intensive care and newborn

nursery In newer facilities or when new units are

added we are seeing private rooms moreavailable

Special units are equipped to staff specialized care, e.g. coronary care,neonatal, recuperative swing beds



Types of Hospitals

Acute care hospital designated asfor-profit or not-for-profit aredifferent only on the basis of

ownership status Other types – VA, short term,

critical care access which providescare for a specific population,duration, locality and may bereimbursed differently



For Profit

For-profit hospitals are usuallyowned by corporations whoseshareholders own a portion of thebusiness, such as HCA (HospitalCorporation of America) and Tenethealth care



Not-for-Profit Hospital

These are typically governed by aboard of trustees or directors anddo not have shareholders

Most not-for-profit hospital areconsidered to be public hospitals,and are owned by a church,community organization,government agency such as acounty



Veterans Hospitals

The federal government establishedVA hospitals in 1930

Veterans with service connectedinjuries or disabilities are treated atno cost

Other veterans may receive

treatment but their insurancecompany can be billed for treatmentof non-service connected conditions



Short-Term Acute Care Hospitals

Short-term acute care hospitalsgenerally provide services topatients recovering from surgery orbeing treated for acute illnesses orinjuries

Short-term care is usually

considered to be less than 30 days



Critical Access Hospitals

Medicare allows some hospitalsexemption from the PPS systems

CAH Critical Access Hospital is asmall Medicare acute care hospitalor clinic or other facility that was ahospital prior to being converted

into a clinic



Critical Access Hospitals

CAH facilities must be located morethan 35 miles from another hospital

The facilities must provide 24 houremergency services, have anaverage LOS of no more than 96hours and be licensed for no morethan 25 beds

Then CAHs are paid based on apercentage of reasonable cost

Class 1 Hospital Services

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