In rural communities, an aging and dwindling population compound the challenges hospitals face in the sectors unending pursuit to raise revenue.
For tiny and large rural hospitals alike, taking advantage of specially tailored payments under MedicareU.S. hospitals single biggest customer and insurer of the nations elderlycan make or break budgets.
Still, one of three initiatives that can boost rural hospital Medicare payments by millions of dollars each year, known as Medicare-dependent hospitals, may be underused because of confusing regulatory language about eligibility criteria. At issue is how hospitals calculate the tally of Medicare patients needed to qualify for the designation.
To be considered a Medicare-dependent hospital, at least 60% of inpatient days must be attributable to patients covered by the federal insurer. Hospitals typically review bills to Medicare to arrive at a number. But one Connecticut hospital tapped an overlooked pool of patientsthose eligible for Medicare but covered by alternative insuranceto qualify. Its an unorthodox route, but one that suggests theres an avenue for other rural hospitals already skirting the 60% threshold.
Windham Community Memorial Hospital, Willimantic, Conn., ignored objections to its maneuver and successfully lobbied the CMS to win approval. For the 79-bed hospital, a close read of the nearly 20-year-old legislation that created Medicare-dependent hospitals added $5 million to its bottom line after the hospital fought for and won the designation by adding Medicare-eligible patients who have alternative insurance.