Tuesday, December 4, 2012

Another New York Hospital Hemorrhages to Death!

 Another New York Hospital Hemorrhages to Death!
Is it time for providers to TOTALLY outsource billing, collecting and appealing?

A Brooklyn hospital, Interfaith Medical Center, has just filed for Chapter 11 bankruptcy. Apparently, the hospital's cash expenses exceed its receipts by two million dollars.The hospital is claiming that they require twenty million from the State to continue operating; actually needing a bailout in order to pay its vendors and meet payroll.

I wholeheartedly  sympathize with the people on the receiving end of such proposed funds. However, as a Providers Advocate who is much too keenly aware of the dismal financial future facing so many providers who continue to resist change,  I am APPALLED at the concept of bailing out ANY institution that does not agree to be held accountable to doing just that: Changing the quantity and quality of the payments due them through health insurance appeals as well as no-fault, workers compensation, and  personal injury claims.

I believe that it is time for providers to let go of the battle so that they can win the war-- before they lose the war. Get out of the claim business and focus on making people well because that is what they do best.

Inasmuch as the average hospital annually leaves approximately 5 million dollars of no fault and workers compensation claims uncollected (average surgical centers actually never even collect on 60% of their No fault and workers comp claims) regrettably I must concur with Kenneth Raske, president and C.E.O. of the Greater New York Hospital Association: “...it may turn out that profound problems with the ways health care is paid for... will make it virtually impossible for all but a small number of the city’s hospitals to stay afloat”  because the hospitals are just NOT getting paid enough for these potentially lucrative services.

In addition, hospitals are losing many more millions of dollars annually because they do not have the staff to consistently and effectively appeal adverse determinations for health care payments from insurance carriers.

Utilization Managers do not have enough resources to deal with myriad claim denials for numerous hospital departments. Bill collection agencies focus on collecting money from the patients  (many of whom are too sick  to appeal their claims)  instead of focusing on the insurance companies who have the means to pay appealed claims.

Hospitals should out-source this end of the business so that every single substantial service they provide by every single department in the hospital,
can be handled in the most profitable way. The time has come.