Modern Healthcare February 10, 2018
After converting to a critical-access hospital in July 2010, Holy Cross Hospital needed to change its billing setup with all the insurers in its network. Medicare makes up 40% of the Taos, N.M., hospital’s patient base.
But one of its contracted carriers balked. UnitedHealthcare demanded that Holy Cross sign a new, different contract for Medicare Advantage enrollees. Under this new contract, UnitedHealthcare would no longer pay for its beneficiaries to stay in Holy Cross beyond four days.
If Holy Cross rejected this change, UnitedHealthcare would simply drop the hospital.
Hospital officials pushed back without luck.
THE TAKEAWAY
The lower reimbursements are a challenge in rural communities with high Medicare Advantage penetration.
“They wouldn’t listen,” says Bill Patten, CEO of Holy...
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