Not all of the news has been bad lately, as far as hospitals are concerned. Recent headlines have included updates from five different medical centers around the United States that are expanded. Although some others (as we’ve covered over the past few weeks) have been struggling, others are in very good financial health. Their good fortune can be attributed to a number of different factors, including a well-balanced financial system. Many of these medical centers understand the need to collect on unpaid and underpaid claims and have no issues tracking them in order to follow the process through to the end. Because of this, they are able to expand their centers and provide better health care to the community around them.
Methodist University Hospital in Memphis Builds New Tower
One hospital that’s taking advantage of its good financial health is Methodist University Hospital in Memphis, TN. This hospital’s expansion includes its new Shorb Tower. “The tower is named after the hospital’s longtime CEO Gary Shorb, who retired in 2016. The addition cost the hospital $275 million dollars, and it opened up earlier this month.” According to Becker’s, “The 450,000-square-foot tower stands nine stories tall, contains 18 operating rooms and has a new parking plaza with 700 spaces. It will be home to transplant, cardiology and oncology services.” That is quite a bit of additional space, and the new tower will add some crucial services to the list of things that Methodist University Hospital can provide.
OhioHealth in Columbus Expands
Although OhioHealth isn’t just a hospital – it’s actually a healthcare system that consists of 11 hospitals and numerous clinics. The system just put the finishing touches on their newest building, one designed to house all of their administrative employees. Prior to this, those workers were in 22 different buildings. Being in one place makes this much more efficient, and will allow them to better coordinate their care – as well as their billing practices. According to Becker’s, “Columbus-based OhioHealth has completed its $90 million administrative building that will house 1,600 employees, according to The Columbus Dispatch.” Although the building was not inexpensive, it will make things go much more smoothly in the future.
CoxHealth Builds New Replacement Hospital
This is technically not an expansion, but it does showcase just how well some hospitals as doing in comparison to others. For example, CoxHealth, the Missouri-based healthcare system, just recently broke ground on one of their newest buildings. The system currently has six hospitals in their chain, with one of the oldest being around 66 years old. It’s time for a replacement. According to sources, “the $42 million new facility, Cox Monett (Mo.) Hospital will be a full-service hospital with an emergency department, multiple operating rooms, and labor and delivery services. Attached to the hospital will be a physician office with clinics and 40 exam rooms. The 270,000-square-foot facility is near Riverside Methodist Hospital. Construction began in spring 2017.” Basically, they aren’t just replacing a hospital – they’re making it better. In a time where many rural hospitals are failing, it’s nice to see one succeeding.
Emory University Plans a Massive Expansion Project
Emory University, based in Atlanta, GA, recently “filed a rezoning application with the city of Brookhaven, Ga., describing its plans for a $1 billion “health innovation district,” according to the Atlanta Business Chronicle.” The article goes on to say that, “Emory purchased roughly 60 acres in Executive Park in Brookhaven in 2016. In the rezoning application, Emory said it plans to use the property for mixed-use development, including medical services, a hospital, a hotel, and commercial space. The new development would add to “the successful programs in orthopedics, sports medicine, brain health, medical science education and health information technology already located on the site,” according to the report. The new development, which could take 15 years to finish, would be across the street from a new $1.5 billion hospital campus being built by Children’s Healthcare of Atlanta, according to the report.” This one-billion-dollar project, if approved, would change the overall look of the area, as well as add to the services that the University can offer. Currently, Emory runs Emory University Hospital, a facility with over 700 beds, that operates as a training ground for their medical school students.
Yale Plans an $800 Million Dollar Expansion
Yale’s New Haven Hospital is starting a very important expansion of their Saint Raphael campus. According to sources, the “new 505,000square-foot project would include two patient facilities, with a combined 204 inpatient beds, according to the hospital. It would focus on innovation in the neurosciences and be one of the largest such projects in Connecticut’s history.” In addition to this, “The neurosciences center will be built within the current Saint Raphael campus footprint. According to the hospital, its main entrance will move from Chapel Street to George Street, and the parking garage on Orchard Street will be extended to George Street. A new 200-space underground garage is also part of the project.” This expansion is an important one, as it will allow the hospital to handle a number of additional services and complete some important studies in the neuroscience field.
How Can a Medical Center Remain in Good Financial Health?
All five of these medical centers have one thing in common – they are all in good financial health. How did they get there? They have billing teams that know how to go through the state-level appeals. In some cases, they also contract with a separate company (like ours) that specializes in filing Federal ERISA appeals. This combination of factors, as well as having a solid base of patients, means that these systems have what it takes to expand and make their hospitals and clinics even better.
What Those Three State-Level Appeals Really Mean
Every commercial health insurance claim is allowed to go through the appeals process. At the state level, they receive three of these appeals. This means that the claims can be sent back (and rejected) by the insurance company exactly three times. In some cases, these claims are paid after the first appeal. The problem might be that they contained incorrect information, such as coding, names, and other details. In other cases, the claim might not be paid at all, leaving it sitting on the wrong side of the balance sheet.
Filing Federal ERISA Appeals
When the claim is finished with its three state-level appeals, it tends to end up in a debt bucket, where it’s allowed to add up. In many cases, this debt is allowed to sit there and nothing is done about it. However, there is one way to ensure that these commercial health insurance claims get paid – the Federal ERISA appeals process. According to this set of laws, those claims must be paid, as long as they are submitted properly. This requires an expert in the field who is trained to submit and follow up on them.
We Can Help
If you find your hospital or clinic is inundated with unpaid or underpaid commercial healthcare claims that have exhausted their state-level appeals, please contact us. We specialize in getting those claims paid via the Federal ERISA appeals process. You can reach out to us here.