New centers will get relief in Medicare survey mess
Deemed status may replace HCFA surveys
When Aurora Health Center opened in Waukesha, WI, in October, managers expected a survey for Medicare certification soon. After all, the center's application had been filled out two months earlier.
After a few months passed, Kelly Gunnelson, RN, MBA, supervisor of intervention services, learned that the Baltimore-based Health Care Financing Administration (HCFA) had run low on money to pay states to conduct surveys.
"We can't do any Medicare patients," Gunnelson said in March. "We won't be reimbursed. You can imagine how much of an impact that would be for any surgical facility."
Fortunately, relief is on the way for Gunnelson and others who have been caught by the federal budget crunch that limited HCFA's survey resources.
Gunnelson found out in mid-March that surveyors had been funded and would visit the center. Meanwhile, at press time, HCFA was on the verge of issuing a proposed notice in the Federal Register for granting "deemed status" to accrediting bodies. In other words, if a center is accredited by the Skokie, IL-based Accreditation Association for Ambulatory Health Care or the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations, it is automatically deemed to be certified for Medicare reimbursement by HCFA. HCFA expects to publish a final rule this summer.
The problem mostly affected new centers that needed an initial survey to get a Medicare provider number and to begin treating Medicare patients. HCFA is bound by law to survey nursing homes and home health providers each year, which made ambulatory surgery centers a lower priority, says Terri Harris, MBA, a health insurance specialist with HCFA.
"Last year, our survey budget was the same as it was for a year ago, and there was a big boom in home health agencies," Harris says. "The money just gets eaten up fairly fast."
Leaders in the ambulatory surgery field have been awaiting "deemed status" for years.
"We have made great strides in getting our case in front of HCFA in terms of what deemed status would mean to them," Ray Grundman, general manager of Surgicenter of Greater Milwaukee, who is past president of the Wisconsin Surgery Center Association in Madison and a board member of the Alexandria, VA-based Federated Ambulatory Surgery Association.
"If [HCFA] is short of money, deemed status would make all the difference in the world," says Grundman. "Surgery centers do save the Medicare program a tremendous amount of money [when compared with costs at other facilities]."
[Editor's note: For more information about deemed status, contact Terri Harris, Health Insurance Specialist, Health Care Financing Administration, 7500 Securities Blvd., S2-19-05, Baltimore, MD 21244. Telephone: (410) 786-6830. Fax: (410) 786-6730.] *
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