US · guidance
CMS Pub. 100-04, ch. 3, § 150.14.1
Crossover Patients in New LTCHs
When a hospital undergoes a change in ownership or a change in classification from an
acute care hospital to a LTCH, payment issues arise for “cross-over” patients who were
admitted prior to the change in classification who are still hospitalized under the new
provider number. Since all LTCHs are required to be certified as hospitals and generally
be paid under the IPPS, for 6 months prior to designation as a LTCH, in 42 CFR
412.23(e), there are “cross-over patients,” at the creation of every LTCH, who were
admitted to the facility when it was an acute care hospital. The policy was to discharge
the patient under the acute provider number and readmit the patient under the new LTCH
provider number (see section 100.4.1 of this chapter). Medicare paid twice for what was
really one episode of care since separate payment would be made to both the acute
hospital and the LTCH. Effective October 1, 2004, Medicare will issue one discharge-based payment to the LTCH that discharges the patient, under the applicable payment
system.
In the regulations at 42 CFR 412.521(e) we provide a payment methodology for such
cases in which Medicare will consider all the days of the patient stay in the facility (both
prior to and following the date of LTCH designation) to be a single episode of LTCH care.
Payment for this single episode of care will include the day and cost data for that patient at
both the acute care hospital and the LTCH in determining the payment to the LTCH under
the LTCH PPS. Furthermore, the days of the patient’s stay both prior to and following
designation as a LTCH are counted in determining the patient’s total length of stay at the
LTCH both for payment purposes as well as for the LTCH’s average length of stay
(ALOS) calculation under 42 CFR 412.23(e)(2) and (3).
Bills paid to the facility for crossover patients when the facility was paid under IPPS must
be canceled, so that the entire stay can be billed under the LTCH provider number and
paid for under LTCH PPS.
History
(Rev. 267, Issued 07-30-04, Effective: 10-01-04, Implementation: 01-03-05)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b05f0fbe88cc713d4d3d1d4ec50503b59a4db3bf108d454887318db248756515
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