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.