It’s no surprise that Critical Access Hospitals nationwide are negatively impacted by COVID-19. As of November 2nd, Kansas has had 89,227 COVID-19 cases, 3,893 hospitalizations, and 1,046 statewide deaths. Just a few weeks ago, a rural hospital in southwestern Kansas was unable to care for a severely ill patient with COVID-19. The patient needed to be treated in the ICU, however, the closest ICU was completely full, and the nearest open ICU was seven hours away. Once there was eventually a spot in the closest ICU, the patient was in desperate need of being intubated and was starting to decline. The coronavirus is starting to get worse, and the Critical Access Hospitals are beginning to struggle.

What’s The Issue With Critical Access Hospitals?

Critical Access Hospitals are struggling the most during this pandemic because they are under the most financial distress. Over the past 15 years, 174 rural hospitals have had to close in the United States and the pandemic is only accelerating this trend. So far, 15 rural hospitals have closed in 2020 due to hospitals being forced to cancel elective surgeries, which is the main source of their revenue. Among the rural hospitals that remain, more than half of them don’t have an intensive care unit.

Before the pandemic hit, smaller hospitals were already unable to maintain their hospital status under the current payment system. “Rural areas have fewer commercial payers than more urban markets, which means these hospitals have a higher volume of state-funded healthcare with lower reimbursement rates,” according to Becker’s Hospital Review. Larger hospitals can dedicate individuals to deal with these difficulties of filing rules, which helps decide which facility receives the applicable reimbursement to be in their favor. Critical Access Hospitals lack resources in this department; therefore, they often miss out on various reimbursement opportunities which leads to financial distress.

How Midland On-Call Can Help Critical Access Hospitals

Here at The Midland Group, we believe that Critical Access Hospitals are not only vital in the creation of jobs and opportunities for communities, they also allow businesses to continue opening their doors. That is why we created Midland On-Call: Patient Advocacy and Self-Pay Solutions, which is reserved exclusively for Critical Access Hospitals. The Midland Group believes that Critical Access Hospitals should have the same resources and firepower that is traditionally reserved for large acute care hospitals and multi-provider-based healthcare systems.

Features of Midland On-Call Include:

Public Benefits Eligibility Solutions consisting of Medicaid Screening & Application Processing, SSI/SSDI, Crime Victims Compensation, etc.

Early Out Support which includes prompt-pay and negotiating payment plans.

Managed payment plans at no cost to your hospital.

Financial Assistance Screening and assistance with the application.

Accident Recovery Solutions consisting of PIP/Med-Pay capture, hospital lien filing, and Workers’ Compensation follow-up.

Annual 501(r) compliance consultation & legal review, ongoing business office training & support, and much more.

You get to choose how patient-centered resources are applied to your patient population.

Now What?

If you are part of a Critical Access Hospital and you’re struggling, know that you aren’t alone. The Midland Group has helped large and small facilities increase billing efficiency and maximize reimbursement rates. As a member of the Midland On-Call program, you can ensure that your patients are receiving the advocacy they need to qualify for public healthcare benefits and the information they need to resolve their self-pay balances with your hospital. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

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Before the coronavirus pandemic, approximately 27.5 million Americans did not have health insurance. Since then, this number has increased dramatically. As businesses all over the country laid off close to 30 million U.S.workers, many more workers and their families have lost health coverage benefits. 

As a whole, COVID-19 has highlighted a significant gray area around healthcare billing, coding, resource allocation, and patient financial responsibility regarding coronavirus-related care. As such, it can be easy for people to get caught up in the whirlwind of ongoing updates and information regarding the specifics on coronavirus-related resources. 

To help you stay informed, our team has compiled a quick summary of the most important resources relating to the coronavirus and what that may mean for you and your family.

Families First Coronavirus Response Act (FFCRA)

In March 2020, Congress passed 2 stimulus bills aimed at assisting people without health coverage.

The first is the Families First Coronavirus Response Act. The FFCRA gave states the choice to use Medicaid to cover COVID-19 testing for those who are uninsured. While this testing covers both lab work and office visit, however, this bill does not help with actual treatment of COVID-19, should patients test positive.

While the Trump administration declined to reopen access to the Obamacare exchange, this concern did lead to the passing of another bill, the CARES Act.

Coronavirus Aid, Relief and Economic Security (CARES) Act

Complementary to the first bill, the CARES Act was designed to reimburse hospitals for coronavirus testing as well as necessary treatments for people who test positive. Reimbursements to healthcare providers are allocated from the bill’s $100 billion budget to be paid out at Medicare rates.

To qualify for reimbursement through this program, providers must have conducted testing and treatment on or after Feb. 4. In addition, providers must also complete the following steps: 

• Check the patient for coverage eligibility.
• Verify that the patient is truly uninsured and does not have any form of health care coverage, including any individual, Medicare, employer-sponsored, or Medicaid coverage.
• Confirm that no other payer source will reimburse the costs of testing and/or treatment conducted for the patient, whether partial or in full.

To learn more, visit COVID-19 Claims Reimbursement. In addition, providers can also begin the process to file reimbursement claims directly through the Claims Reimbursement Portal.

1135 Waivers for COVID-19

In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) “using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers”. To help healthcare providers contain the spread of COVID-19 and address the financial issues presented, HHS has empowered the Centers for Medicare and Medicaid Services (CMS) to take proactive steps through 1135 waivers. In addition, the CMS has also been granted authority under section 1812(f) of the Social Security Act, which allows for blanket waivers to be implemented. When a blanket waiver is issued, providers are not required to apply for individual 1135 waivers. The blanket waiver related to coronavirus has a retroactive effective date of March 1, 2020 through the end of the emergency declaration. 

Examples of available waivers under section 1135 emergency authority include:

• Extend existing service authorizations until the end of the public health emergency
• Temporarily defer requirements for prior authorization
• Adjust specific timeline requirements for both state fair hearings and appeals
• Loosen deadlines for public notice and submissions in regards to specific Medicaid state plan amendments focused on COVID-19. This allows states to implement faster changes and thus ensure that they can be retroactive to the beginning of the emergency.
• Temporarily suspend prior authorization requirements;
• Extend existing authorizations for services through the end of the public health emergency;
• Modify certain timeline requirements for state fair hearings and appeals;
• Relax provider enrollment requirements to allow states to more quickly enroll out-of-state or other new providers to expand access to care, and
• Relax public notice and submission deadlines for certain COVID-19 focused Medicaid state plan amendments, enabling states to make changes faster and ensure they can be retroactive to the beginning of the emergency.

To learn more, visit COVID-19 Emergency Declaration Blanket Waivers for Health Care. For state-by-state 1135 waiver updates, visit Medicaid.gov’s Federal Disaster Resources. 

About the Midland Group

The Midland Group, in partnership with participating hospitals, is one of the very few companies that is able to deliver the highest returns from Medicaid and other public benefits. Since 1989, our goal has always been to increase people’s access to healthcare and protect the financial health of our partner hospitals. Even in times of unprecedented emergencies, The Midland Group stands by ready to assist patients in our partner hospitals to qualify for various public benefits programs. Our trained patient advocates are familiar with all the tools and ever-changing rules and regulations revolving around all forms of health-related public benefits. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

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