Rural hospitals are lifelines for millions of Americans but face unique operational, financial, and regulatory challenges. At the 2025 AHIMA Conference, Leah Jeffries, RHIT, CDIP, CCS, CCS-P, Managing Consultant at UASI, will present “The Nuances and Complexity of the Revenue Cycle Management of Critical Access Hospitals.” 

For related insights on performance measurement and organizational support, see our PSI and Quality Solutions overview.

This session explores how Critical Access Hospitals (CAHs), small rural facilities designated by CMS, operate under different rules than larger hospitals. With up to 25 inpatient beds, distinct Conditions of Participation, and cost-based reimbursement, CAHs must balance strict requirements with financial stability while serving underserved communities. 

Key Takeaways 

• Learn the history, purpose, and eligibility criteria of CAHs, including cost-based reimbursement and flexible billing options. 
• Understand how Conditions of Participation differ from acute-care hospitals, covering bylaws, quality programs, infection control, and documentation standards. 
• Explore cost-based reimbursement for inpatient, outpatient, and swing-bed services plus Method I and II billing for professional services. 
• Discover common coding pitfalls unique to CAHs, from swing-bed and ambulance coding to anesthesia modifiers and charge validation. 
• Gain strategies to improve documentation, reduce denials, and strengthen compliance despite limited resources. 

Looking Ahead 
There will also be a review recent and upcoming regulatory changes shaping rural healthcare. With over 140 rural hospitals having closed since 2005, attendees will leave equipped to protect reimbursement, improve revenue cycle processes, and sustain access to care. 

Critical Access Hospitals are more than healthcare providers; they are anchors for rural economies. This session offers actionable strategies to help CAHs thrive despite unique challenges. 

If you work in revenue cycle management, health information management, compliance, or clinical documentation, this is a must-attend session at AHIMA 2025. 

Works Cited: 

Centers for Medicare & Medicaid Services. (n.d.). Critical access hospitals.
Available at https://www.cms.gov/medicare/health-safety-standards/certification-compliance/critical-access-hospitals

Centers for Medicare & Medicaid Services. (n.d.). State Operations Manual (SOM), Chapter 2 – The certification process.
Available at https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107c02.pdf

National Center for Biotechnology Information. (n.d.). Rural–urban continuum codes.
Available at https://www.ncbi.nlm.nih.gov/books/NBK587178/figure/ch3.fig22/

U.S. Department of Agriculture, Economic Research Service. (n.d.). Charts of note: Rural population and hospital access.
Available at https://ers.usda.gov/data-products/charts-of-note/chart-detail?chartId=110927