Exception-al CRNAs: Sometimes the Sole Provider in Rural Areas

According to the American Association of Nurse Anesthetists, nurse anesthetists are the oldest nurse specialty group in the United States and have been providing anesthesia care to patients in the United States for more than 150 years. The CRNA (Certified Registered Nurse Anesthetist) credential came into existence in 1956.

CRNAs are the primary providers of anesthesia care in rural America, enabling health care facilities in these medically underserved areas to offer obstetrical, surgical, pain management and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.[1]

The services of a non-physician anesthetist (CRNA) generally are paid for by the Part B contractor based on a fee schedule rather than on reasonable cost basis through the cost report.

But for some qualified rural hospitals or Critical Access Hospitals, a request can be made on an annual basis for an exception if the facility employed or contracted with not more than one FTE (2080 hours) non-physician anesthetist. There is also a threshold of 800 or fewer surgical procedures requiring anesthesia services and there can be no professional fee billing for the CRNA.

Tip #33:

Rural and Critical Access hospitals can request an exception to the CRNA Fee schedule if they meet certain criteria (CMS Pub 15-2, Section 4013). Further guidance can be found on the Centers for Medicare and Medicaid Services (CMS) website:

Provider Reimbursement Manual 15-2, Chapter 40

Questions? Please contact Marie White at 612.253.6546 or mewhite@eidebailly.com.

[1] American Association of Nurse Anesthetists, “Certified Registered Nurse Anesthetists Fact Sheet.”

The Effect of Shrinking Rural America on Medicare Productivity Standards

michael-smithIn 1900, some 40 percent of the population worked in agriculture, a century later, only two percent did.1 Manufacturing jobs in most small towns began to disappear by the 1980s. Rural America, more than much of the rest of the country, is the victim of productivity gains. And in rural America, fewer other opportunities materialize to replace the jobs the machines take.

Our transition from rural to metropolitan has been rapid. At the beginning of this century, 60 percent of the people lived on farms or in villages. Today, just 19 percent of Americans live in areas the Census department classifies as rural, down from 44 percent in 1930.

This week’s tip goes hand-in-hand with our previous posting (please see tip #22) on the importance of accurately calculating your physician and mid-level FTEs for Rural Health Clinics (RHCs). The RHCs could receive enhanced reimbursement from Medicare and Medicaid, but this is dependent upon FTE counts and the relationship to productivity thresholds.

In some situations, a RHC has the necessary physician or mid-level to provide care, but due to declining populations, economic conditions or a combination of these, insufficient patient volumes exist to prevent the RHC from being impacted by the thresholds.

Tip #28:

The Medicare Administrative Contractor that processes Part A and Medicare Part B claims has the discretion to make an exception to the productivity standards based on individual circumstances (Chapter 13, Section 80.4).

Further guidance can be found on the Centers for Medicare and Medicaid Services (CMS) website:

Medicare Benefit Policy Manual RHC/FQHC

Questions? Please contact Michael Smith at 701.239.8635 or msmith@eidebailly.com.

1“The Graying of Rural America,” by Alana Semuels, The Atlantic

Claims Data is “Big Data”

Marie White

Marie White

One of the new buzzwords these days is “big data.” But what exactly is big data? According to the fine folks at Wikipedia, “big data is a broad term for data sets so large or complex that traditional data processing applications are inadequate.” In the world of Medicare, big data is claims data.

Medicare Part A and B claims are processed by the Centers for Medicare and Medicaid Services (CMS) and then summarized in a document called the Provider and Statistical Reimbursement (PS&R) Summary Report. Each provider is responsible for requesting this summary report when the annual cost report is prepared.

The PS&R system has numerous reports that may be generated in addition to the summary report. Payment Reconciliation Reports (also known as Detail Reports) contain detailed, claim-specific data that supports the summary reports.

Providers are permitted to request detail reports, which can be analyzed and compared to internal data and help you better understand the Medicare reimbursement you are receiving.

Tip #6:

Ensure you have access to the PS&R system and are familiar with the steps to request a report.

Users must have an ID and password to access the system. Apply early, as there’s an approval process to obtain these.

Guidance is available on the CMS website:

PS&R Provider Community

Questions? Please contact Marie White at 612.253.6546 or mewhite@eidebailly.com.

 

Payments Can Make or Break You

Marie White

Marie White

“The difference between something good and something great is attention to detail.” Charles R. Swindoll

Medicare pays Acute Care Hospitals for Part A and B services via submitted claims; inpatient is paid under Diagnosis Related Groups (DRGs) and outpatient is Ambulatory Payment Classifications (APCs). Some hospitals can receive added payments for things such as medical education, bad debts, uncompensated care, and others. Medicare will often make additional payments for these items on a periodic basis.

When completing the cost report, it is extremely important to identify the payments you have received on individual claims—these are on a Provider Statistical and Reimbursement (PS&R) report. You also need to include any additional payments you have received for other items. Over- or understating one of these could have a significant impact on the due to/from settlement.

Tip #3:

Confirm and include all pass through and lump-sum payments (Pub 15-2, §4031)

The cost report must include all interim Medicare payments paid on individual bills, pass through payments for services rendered in this cost reporting period.

Further guidance on the types of payments to be disclosed on Worksheet E-1 can be found on the Centers for Medicare and Medicaid Services (CMS) website:

Provider Reimbursement Manual 15-2

Questions? Please contact Marie White at 612.253.6546 or mewhite@eidebailly.com.