Error keeps Nampa hospital out of Medicare, Medicaid business for weeks

St. Luke’s new hospital in Nampa opened Oct. 30, added on to the existing emergency department at 9850 W. St. Luke’s Drive.
St. Luke’s new hospital in Nampa opened Oct. 30, added on to the existing emergency department at 9850 W. St. Luke’s Drive. Idaho Statesman file

An oversight at a new St. Luke’s hospital in Nampa is keeping it from being able to take non-emergency patients who have government health insurance — from its opening Oct. 30 through at least the early weeks of December — unless those patients agree to potentially pay their own hospital bills.

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.

St. Luke’s officials mistakenly thought they didn’t need to have an accreditation survey done immediately after they opened their doors Oct. 30. They believed they could take until January to get ready for the survey, then, after passing and becoming accredited, back-bill for all the services they had done since they opened.

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 Nampa will stabilize patients who come to the emergency room in danger of dying, without charging them more than it would under normal circumstances. But it cannot admit those patients after they’re stable — unless the patients agree to pay out of their own pockets for continued treatment.

Patients who went to St. Luke’s Nampa “before we were made aware of the billing issue will not receive a bill for anything more than they would have paid at a hospital already participating in their insurance,” said St. Luke’s spokeswoman Beth Toal.

The mistake affects a lot of patients and a lot of the new hospital’s business. About 40 percent of St. Luke’s Health System patients are on Medicare and Medicaid.

The billing problem does not change anything for people with private health insurance or no insurance.

All hospitals must be surveyed

St. Luke’s Health System doesn’t have much recent experience opening a brand-new hospital. Most of its “new” hospitals have been existing hospitals it bought, facilities it rebuilt or — as in the case of its Meridian hospital, which is linked to the Downtown Boise hospital — a new facility that it opened under the umbrella of an existing one.

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 The Joint Commission, a private nonprofit that accredits and certifies more than 20,000 health care organizations and programs in the U.S. If it passes its Joint Commission survey, it can bill federal health insurance.

A hospital must be open before it asks The Joint Commission to do a survey. There are several requirements, among them that a new hospital can ask for a survey when it has records for at least 30 patients it has admitted.

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.”

Kathy Moore, CEO of St. Luke’s western region, said the health system did not request an early survey.

“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.

Ben Keith, an associate general counsel for St. Luke’s, said the misinformation was due to “an internal error.”

The error was flagged by an employee in the billing office who tried to get St. Luke’s Nampa’s Medicare number — only to discover one hadn’t yet been assigned.

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 Meridian or another local hospital.

For those patients, and patients who need to be admitted from the emergency room, everything will be as it was before the Nampa hospital opened, Moore said.

Audrey Dutton: 208-377-6448, @audreydutton