As part of its commitment to rural and underserved populations, CMS now gives existing rural hospitals and CAH facilities the option to adopt Rural Emergency Hospital (REH) Medicare provider status to receive additional federal assistance.
But with new regulations and unprecedented growth in secondary healthcare, many would-be REHs are struggling to effectively link clinical systems to an increasingly complex financial workflow.
This post covers the specific business office services that MEDHOST can deploy to help ensure that rising patient volumes and increased revenue cycle demands don’t disrupt these facilities' efforts to provide lifesaving, value-based care for their communities.
Rural Emergency Hospitals are filling a major void in their communities.
While Freestanding Emergency Rooms (FSED) have dramatically increased access to care, they haven’t been effective in meeting the needs of rural populations. In the last 25 years, demand for rural emergency care has grown at the same rate that non-rural hospital emergency departments have closed, according to The Journal of the American Medical Association.
Having fewer resources and staff, the business offices of smaller healthcare facilities are often under considerable pressure to reduce the amount of time accounts are overdue, ensure positive cash flow, recover missing payments and identify billing errors. With these competing responsibilities, it’s not uncommon for bottlenecks to form.
Working closely with facility staff, MEDHOST leverages an in-house team of business services experts to overhaul facility accounts, root out the areas where revenue had been left on the table, and sketch out a roadmap for manageable, sustainable growth.
Before collaborating with MEDHOST, our business office services experts find that many hospitals have been making small errors in billing visit codes, which can add up on a hospital’s balance sheet over time.
The culprit behind these billing mistakes is often one endemic to healthcare back offices: outdated practices. In an industry obsessed with protecting patient data, the security associated with these manual processes—such as mailing patient statements and bills— has kept healthcare in the dark amid a revolution in digital-first business practices.
Another challenge that we identify when working with hometown providers are the complexities surrounding the management of charge masters. The chargemaster—a list of billable items and services the hospital provides—can only be increased to a certain degree before payers want to be notified. This allows insurance companies to renegotiate contracts if facilities implement significant changes that might impact payments.
It’s in the best interest of the hospital and the payers to negotiate and maintain mutually beneficial agreements. Hospitals that fail to keep insurance in the loop risk underpayment and other billing errors.
Understanding the expectations of payers, knowing when and where to come to the table over these contracts, and managing the financial benefits and risks of chargemaster increases, requires years of contract management experience and may be difficult for smaller hospitals that lack the experienced RCM staff of larger providers.
It’s not uncommon for facilities to have a backlog of unprocessed claims. Traditional account follow-up can be a pain point, especially at small to midsized hospitals. With the pressure of day-in-day-out responsibilities, it becomes easy to put old accounts on the back burner—especially when staffing challenges complicate the process.
Without knowledgeable and experienced billing experts scrutinizing claims, hospitals are often forced to rely on insurance companies for accurate reimbursement. Unfortunately, payers are incentivized to compensate hospitals as little as possible or deny claims entirely.
As an extension of the hospital’s existing team, MEDHOST can help maximize payments by building and maintaining existing agreements, attaching them to the correct payer plans, flagging inaccuracies, and overseeing the recovery process from start to finish.
Streamlining the revenue cycle to meet the demands of today’s business environment can be a daunting task. Regulations, inflation, rapidly evolving markets and stubborn workforce challenges only complicate attempts to improve business operations. But by teaming up with a dedicated revenue cycle management partner, your business office can access the tools and expertise they need to fix leaks and get revenue flowing again.