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St. Luke’s Nampa gets green light to bill Medicare, Medicaid after mistake

St. Luke’s opened its new hospital in Nampa at 9850 W. St. Luke’s Drive on Oct. 30.
St. Luke’s opened its new hospital in Nampa at 9850 W. St. Luke’s Drive on Oct. 30. doswald@idahostatesman.com

A hospital in Nampa that opened around Halloween is now allowed to bill government health insurance plans.

St. Luke’s opened its new hospital in Nampa on Oct. 30. But an oversight kept it from treating non-emergency patients who had government health insurance — unless those patients agreed to potentially pay their own hospital bills. That affected patients with Medicare, Medicaid, Tricare and Medicare Advantage plans.

St. Luke’s officials thought they had until January to receive the accreditation survey they’re required to pass in order to bill Medicare and other government insurance. They figured that after passing that survey in January, they could back-bill for all the services since Oct. 30.

But they learned in early November that back-billing to the date the hospital’s doors opened is not allowed. That meant that, for a large share of of St. Luke’s Nampa patients, the hospital had to write off the costs of emergency services and had to either reschedule non-emergency patients or refer them to other hospitals or health care providers.

When a hospital first 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.

When officials at St. Luke’s Nampa realized their mistake, they called the Joint Commission and asked to have their survey as soon as possible in December.

The hospital passed its Dec. 7 commission survey. It learned this week that it now has Medicare approval and can back-bill for services provided in the past couple of weeks.

How much money did the hospital lose during the five weeks it couldn’t bill Medicare, Medicaid and other government insurance?

“It wasn’t a lot,” said St. Luke’s West Region CEO Kathy Moore. “Most all of our patients were either rescheduled or were rescheduled to another facility within St. Luke’s, or we rescheduled them to be after the first of the year. ... We saw a lot of shift in our volume from what we anticipated in Nampa to Meridian.”

Moore said she was “really pleased” with the hospital staff’s understanding of the situation and “ability to communicate compassionately to our patients” what was happening.

Audrey Dutton: 208-377-6448, @IDS_Audrey

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