The U.S. Department of Health & Human Services, Centers for Medicare and Medicaid Services’ Hospitals Without Walls Program (the “Program”) may be more crucial to helping hospitals handle the latest surge in COVID-19 cases following the holiday season than at any time previously during this pandemic. As ICU availability rates drop across the country, ambulance crews are advised not to transport patients to the hospital who are unlikely to survive, and hospitals struggle to provide appropriate personal protective equipment to their workforce and medical equipment to their patients, ambulatory surgery centers (“ASCs”) are in a unique position to help take some of the pressure off.
For ASCs considering whether to enroll in the Program, now may be the time. Under the Program, Medicare-enrolled ASCs can temporarily enroll in Medicare and be classified as a hospital during the current public health emergency. The purpose of the Program is to help increase hospital capacity in order to take care of more patients. Enrollment in the Program permits an ASC to bill for its services as a hospital. Medicare hospital reimbursement rates range from 50 to 90 percent higher than ASC reimbursement rates. Under the Program, an ASC can expect to be paid by Medicare as if it were a hospital.
Prior to enrolling in the Program, there are some housekeeping items that should be attended to as follows:
- The ASC should consult with its professional liability insurance carrier to confirm that the indemnity language in its policies covers hospital services and is not just limited to ASC services.
- If the ASC is leasing its space, the ASC should review its lease for any limitation on the permissible scope of services under the lease and any applicable notification requirements related to a change in the scope of services.
- The ASC should ensure that its billers are familiar with hospital billing or find a billing company to assist with billing for hospital services. It is important to note that an ASC’s Medicare billing privileges for ASC services will be deactivated upon obtaining hospital billing privileges. An ASC cannot bill Medicare as a hospital and ASC concurrently.This restriction, however, does not apply to commercial insurance.
Once these preliminary matters are addressed, enrollment in the Program is a two-step process.
Step One: Notify Your MAC
For a Medicare-certified ASC wishing to temporarily enroll as a hospital under the Hospitals Without Walls Program, the ASC must call its Medicare Administrative Contractor’s (“MAC’s”) COVID-19 Provider Hotline to notify the MAC that the ASC intends to enroll in the Program. Customer service representatives are available Monday-Friday from 8 a.m.-6 p.m. CDT. The following information should be available before calling: Legal Business Name, NPI, Tax Identification Number (TIN), address information, an ASC owner’s name and social security number, contact information and any information pertaining to compliance with conditions of participation, as appropriate.
Step Two: Attestation & Request Section 1135 Waivers
The ASC will then need to complete an Attestation and submit the attestation to its MAC contact for processing. It will take approximately two days to receive hospital billing privileges from the date of submission of the attestation.
If the ASC can’t meet all of the conditions of participation in the program, then it should apply for a Section 1135 Waiver of the applicable condition(s). Note that on November 25, 2020, CMS waived the requirement that enrolled ASCs have a registered nurse on duty at all times.
Once the ASC has enrolled in the Program and obtained a CMS Certification Number (“CCN”), the ASC should complete the following items:
- Notify your contracted commercial health plans that you have received a hospital CMS certification number (“CCN”).
- Notify your accreditation organization that you have received a hospital CCN. While the ASC is enrolled in the Program, the accreditation organization may not have jurisdiction over the ASC (instead, the state will).
- Notify your state’s hospital licensing agency to determine whether a temporary hospital license is required
Each ASC will have unique considerations that may affect enrollment procedures in the Program and applicable rules and regulations may vary by state. For questions regarding enrollment in the Program and assistance with enrollment, reach out to your contact at Goodwin or a lawyer in Goodwin’s healthcare practice.