Error keeps Nampa hospital out of Medicare, Medicaid business for weeks
The hospital is licensed to treat all patients. But it has yet to get the approval it needs to bill federal health insurance plans including Medicare, Medicaid, Medicare Advantage and Tricare.
But they learned earlier this month that back-billing to before accreditation isn't allowed. They called their accrediting agency to ask for a quicker survey, which they hope will be conducted in early December. (The surveys are unscheduled and unannounced.)
That means any patient with Medicare, Medicaid, Medicare Advantage or Tricare health insurance will have to go to another hospital or pay out of pocket, for now.
St. Luke's
Patients who went to St. Luke's
The mistake affects a lot of patients and a lot of the new hospital's business. About 40 percent of
The billing problem does not change anything for people with private health insurance or no insurance.
All hospitals must be surveyed
When a brand-new hospital opens, it must have federal approval to start billing government health insurance plans. To get that approval, it can request accreditation from
A hospital must be open before it asks
The commission told the Statesman there is no typical time period between when a hospital opens and when it asks the agency for a survey.
The commission does offer a special, time-sensitive option for new hospitals. It involves a survey done as early as two months before the hospital opens, followed by a full accreditation survey after the hospital opens.
"The Early Survey Option allows a hospital new to Joint Commission accreditation to enter the accreditation process in two stages," the commission's accreditation guide says. "For a new organization, this makes it possible to set up the business operations on a foundation of compliance with administrative and organizational standards before the first patients are served."
"Any new hospital that has a new hospital license and applies for a new Medicare provider number is in this exact same situation. So I wouldn't want to say that we have a problem with our accreditation," Moore said. "We have to be open before they can come in and survey us. ... It's not an unusual position, necessarily, to be in."
How did this happen?
"We were operating under information that was not accurate," Moore told the Statesman. "We thought that we could, once we had our survey, that Medicare allowed us to back-bill our patients ... back to the date of opening."
But that's actually not allowed. Medicare only allows hospitals to bill back to the date of their accreditation survey.
The error was flagged by an employee in the billing office who tried to get St. Luke's
So, if St. Luke's still has to take all patients coming into the hospital with emergencies, but cannot bill for many of those patients, how much money is the hospital going to lose?
"We haven't done a real deep dive" into that, Moore said, adding that officials are considering the losses "part of the cost of opening a new hospital."
The hospital has not communicated the problem broadly to the public. It is rescheduling some patients who have upcoming hospital procedures to the St. Luke's hospital in
For those patients, and patients who need to be admitted from the emergency room, everything will be as it was before the
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