Election of cost reimbursement for CRNA services

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Home ► PARD provider reimbursement ► Election of cost reimbursement for CRNA services

Last Modified: 10/15/2024 Location: FL, PR, USVI Business: Part A

Election of cost reimbursement for CRNA services

Rural hospitals and critical access hospitals (CAHs) or hospitals/CAHs reclassified to a rural area can qualify for reasonable cost reimbursement of anesthesia services performed in the hospital or CAH by a qualified non-physician anesthetist if they meet certain criteria and obtain approval for the CRNA/AA cost reimbursement. Non-physician anesthetists are defined as certified registered nurse anesthetists (CRNAs) and anesthesiologist assistants (AA).

All providers who qualify for CRNA pass-through status:

• Must have employed/contracted with a CRNA in 1988 and must demonstrate that their volume of surgical procedures requiring anesthesia services did not exceed 800 procedures during calendar year 1987.

• New facilities are not eligible for this payment. Since CAHs came into existence in 1997, all CAHs must have been a hospital in 1987-88 in order to qualify for CRNA pass-through status.

• CAHs would submit the 1987-88 data for the hospital provider that they were prior to becoming a CAH.

If your facility was approved for CRNA status for 2024, we maintained the documentation to support the 1987, 1988 qualifications; you do not need to resubmit this information. However, if you were not an approved CRNA status facility for 2024, you need to submit qualifying documentation for 1987 and 1988.

Please submit written requests for CRNA status evaluation to our office prior to January 1, 2025. This is a mandated deadline, and we cannot make exceptions for late receipt of information. Manual reference for election of cost reimbursement for CRNA services can be found at 42 Code of Federal Regulations (CFR) 412.113(c).

All facilities pursuing CRNA cost reimbursement for anesthesia services for calendar year 2025 must submit copies of the following information with your request:

• Written, signed, and dated agreements with the CRNA/AAs under contract or employment for services to be rendered during the period of January 1 – December 31, 2025. Hospitals or CAH may employ or contract with more than one anesthetist, however, the total number of hours of service furnished by the anesthetists may not exceed 2,080 hours per year.

• Current CRNA/AA license.

• Surgical procedure logs (inpatient and outpatient) for the facility’s entire patient population demonstrating the number of surgical hours and number of surgeries requiring anesthesia services (include name of CRNA/AA and surgical hours utilized for each procedure) for the period January 1 – September 30, 2024. Annualized surgical procedures for this period should not exceed 800 surgeries.

• Written, signed, and dated attestation agreements stating that the CRNA/AA has not and will not bill on a reasonable charge basis for his or her patient care to Medicare beneficiaries in that hospital or CAH for the period of January 1 – December 31, 2025.

• Documentation that the hospital or CAH location is in a rural area as defined for prospective payment system purposes or has been reclassified as rural under 42 CFR 412.103.

Send all information electronically to:

ReimbursementJN@fcso.com

All files containing protected health information should be encrypted with passwords. Do not send passwords to open secured files in a separate email. Passwords may be faxed or communicated via phone, person-to-person. Do not leave passwords on voicemail. You may fax passwords to Theresa Bigsby at 904-361-0437.

Please direct questions concerning the CRNA cost reimbursement evaluation process to Theresa Bigsby at theresa.bigsby@fcso.com.

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