This review is not based on an experience in or with Jackson Hospital of Montgomery. It is based on my reaction to the hospital's dire circumstances of operating in the red, teetering on the verge of bankruptcy, and blaming and suing one of the most historically reliable hospital third-party payers for its condition. It is sad to see hospitals across the state struggling to stay afloat. It is a serious problem. There are many causes contributing to the problem. A smart approach for a hospital provider to take to ensure that it is not the problem, starts with an honest, in-depth analysis of in-house processes to identify how much of the blame is on Jackson Hospital. Have you given up too much in quality accounts receivable management starting at the clerical level because of riding the DEI train which may no longer even be legal for entities receiving federal funding. Did you buy into the mantra drilled into hospital business office management by IT experts that electronic claims filing removed all need for human in-house oversight of the accuracy of data entered on claims. That was the stuff of fairy dust and Unicorns. Before blaming the payer for your poor revenue stream, do you know the length of days from patient discharge to claim filing date, the number of days that accounts are in receivables by payer, number of claims denied by denial code, and for every denied claim how many are there that the reason for non-payment cannot be assigned to the payer. Computers may identify a problem enough to deny a claim for payment but they cannot and do not identify the cause of the problem and how to correct it. Only a human can do that. If you do not have one experienced, intelligent, merit-based-hire employee whose primary responsibility is to daily research, analyze, appeal if appropriate, resolve, and report on those aspects of your third-party receivables, there is not enough accountability on your end to blame anyone else. It also seems odd/off that you are attempting to use the lawsuit tactic on a historically reputable third-party payer that was recently used on a historically troublesome payer---it looks like a lazy, desperate move of copy-catting to put all payers in the same league. They are not. I am not affiliated in any way with any payer. This is interesting to me from my seventeen years of experience managing and consulting to optimize revenue from third party payers. How clean are your Medicare and Medicaid claims and how successful are your appeals when claims are denied? And one more thought. The hospital website mentions a hospital chapel is being constructed. For goodness sake, what type of hospital in the South has not had a chapel?! Ewwww. read more
