Did you know rural hospitals and critical access hospitals (CAHs) or hospitals/CAHs reclassified to a rural area may qualify for reasonable cost reimbursement of anesthesia services performed by a qualified non-physician anesthetist if they meet certain criteria and obtain approval for cost reimbursement?
This is commonly referred to as the certified registered nurse anesthetists (CRNA) exemption because the services are exempt from being billed to Medicare Part B on the Centers for Medicare and Medicaid Services (CMS) 1500 form. Instead, services are included on the Medicare Part A billing form UB-04 CMS-1450. Non-physician anesthetists are defined as CRNAs and anesthesiologist’s assistants (AAs).
This is an annual election and is made on a calendar-year basis. You can find the manual reference for election of cost reimbursement for CRNA at CFR 42 Section 412.113(c).
Review Action Items
All hospitals pursuing CRNA cost reimbursement for anesthesia services for any calendar year must submit a written request to their Medicare Administrative Contractor (MAC) before January 1 of the applicable calendar year.
The written request must include the following information:
Check with Your MAC
Required documentation and due dates differ among the MACs. Confirm with your MAC the necessary documents (contracts, written agreements, attestations) and due dates that must be submitted/met in order to qualify for the CRNA cost reimbursement option. Some MACs notify hospitals of their requirements if the hospital has previously qualified for the CRNA exemption. Other MACs post a reminder bulletin on their websites.
If your hospital hasn’t qualified in recent years and believes it may qualify for an upcoming calendar year, contact your MAC to determine the necessary documents and due dates. Regardless of the individual MAC requirements, all requests must be made prior to January 1.