Expeditive Adds New Service Line For Critical Access Hospitals

On May 9th, Expeditive sent out a press release announcing that we are now providing remote Medicare billing services for critical access hospitals. This is a service we’ve been offering for awhile, but we finally decided it was time to get the word out about the service.

The reason this works well is because of the unique nature of critical access hospitals, that being their accessibility and, often, the costs of bringing multiple billing personnel in when a CAH has difficulties in cleaning up their A/R. Also, many CAH facilities find that it’s difficult finding qualified people in their area that they wouldn’t have to spend a lot of time with as far as training goes so that they would be of that much help if something needed to be done quickly.

There are two things to add to this press release. One, because we have access to billing personnel across the country, it’s possible that we might already have someone who either lives in your state or has worked on claims in your state. That’s always a bonus, because even though Medicare is basically Medicare wherever you go, each state’s fiscal intermediary seems to have something different than another state. And even if we didn’t have someone familiar with your state, it’s a short learning curve in getting up to speed on the local rules.

Two, though we announced this for CAH’s, it’s a service that other hospitals could negotiate with us as well. Most of the time, we find that larger facilities like the idea of having people on hand to see what they’re doing, and that’s not a problem with us.

We’re glad to have the opportunity to get the word out on this service; stay tuned for more things as we grow.

Why A Specialist? Critical Access Hospitals

Sometimes people want to know why a specialist might be needed when a general consultant can usually do so many things, often quite well. Let’s take a look at the needs of a critical access hospital as an example.

Critical access hospitals are small. They’re located in rural areas, at least 35 miles from other hospitals, or 15 miles from another hospital in mountainous terrain or areas with only secondary roads. In other words, they’re pretty remote. For Medicare purposes, they’re paid based on costs, which means in many instances they’ll get paid more than their other counterparts because their needs are unique.

This usually means that more impetus should be given to things such as how charges are captured, how they’re priced, and ultimately how they’re billed out. Charge capture is important because CAH’s must be vigilant in making sure that they’ve captured every potential billable item and procedure that they’re allowed to charge for. Pricing is important because hospitals not only need to make sure they’re not under-charging based on Medicare reimbursement, but not pricing themselves so far out of range that they would trigger an audit. And billing is important because many services have relationship issues, which means that other charges, supplies, or pharmaceuticals are either supposed to be billed along with the main charge, or are a component of that main charge and thus aren’t allowed to be billed.

Not all patient account directors know these types of things because they didn’t have to know it in their background. Some hospitals have a charge master person who handles that sort of thing. Most hospitals leave all charging issues up to others who have set those rates, never going back to see whether the rates are in line with Medicare or other insurance company reimbursements. CAH’s need interim staff that truly is more of a jack of all trades, who understands both charges and billing at the same time, to truly be effective.

Going through an agency such as Expeditive helps to verify that a client’s time isn’t being wasted by looking at people who don’t have a background that shows they have skills in many different areas. Trying to hire the right person sometimes can take a long time in rural areas, so hiring an interim consultant with those skills already present makes a lot of sense.