Becker's Hospital Review

15 CFO / FINANCE Tennessee hospital blames involuntary diversion for closure By Ayla Ellison C umberland River Hospital in Celi- na, Tenn., will remain closed, own- er and CEO Johnny Presley told the Livingston Enterprise in December. e rural hospital closed Aug. 7, 2020, and placed its license on inactive status. At that time, Mr. Presley cited several reasons for the closure, including a severe staffing short- age and the inability to secure funding or grants from the state. Mr. Presley told the Livingston Enterprise that the main cause of the closure was the local EMS not bringing patients to the hospital. He says Clay County (Tenn.) Op- erational Medical Director Mark Press- ley, DO, instructed the EMS to divert patients to other hospitals. "I'm not going to reopen the hospital until these problems with EMS in this county are resolved. … e local EMS blatantly refuses to transport patients to this hospital, which is a violation of Medicare rules and also a vio- lation of patients' rights," Mr. Presley told the Livingston Enterprise. Mr. Presley first claimed in August that pa- tients were denied transportation to Cumber- land River Hospital by the local EMS. At that time, Dr. Pressley said he met with the hospi- tal's CEO and the Clay County EMS director in April to review the hospital's capabilities. He asked for updates as the hospital's capabil- ities increased. He said he received no further communication, according to News Talk 94.1. e August closure marked the second time Cumberland River Hospital has closed in re- cent years. e hospital closed in March 2019 due to financial challenges. About five months later, Mr. Presley acquired the rural hospital. He reopened the facility April 18, 2020, aer buying new equipment and supplies and se- curing a Medicare provider number. n Ambulances remain exempt from surprise-billing legislation By Alia Paavola A lthough President Donald Trump signed a measure to ban surprise billing for emergency and scheduled care Dec. 27, ground ambulance rides — the largest source of unexpected out-of-network medical bills — were left out of the legislation, according to The New York Times. The law bans providers from billing patients out-of-network rates when they re- ceive care from out-of-network physicians unexpectedly. It also holds patients harmless in these situations. According to the Times, lawmakers saw adding ambulances to the measure as being too hard, and they were worried about arguing with local governments, which typically oversee the services. Lawmakers also had little data on the ac- tual cost of ambulance trips, the Times reported. "From a policy standpoint, the omission of ground ambulances is huge," Karan Chhabra, MD, a surgical resident at Brigham and Women's Hospital in Boston who has studied the issue, told the Times. "It affects a really large number of people, even if the size of the bills isn't eye-popping." Research by Dr. Chhabra found that 71 percent of ambulance rides may result in a surprise bill, resulting in $129 million in surprise bills each year, according to the Times. The average cost per patient breaks down to $450. This is not the first time lawmakers have left out ambulances in surprise-billing proposals. In 2019, senators left ground ambulances out of fixes as well, citing that states can regulate those rides. n OIG tags Kansas hospital for erroneous billing By Alia Paavola P rovidence Medical Center, a community hospital in Kansas City, Kan., failed to comply with Medicare billing requirements for 13 of 100 inpa- tient and outpatient claims reviewed by HHS' Office of Inspector General, according to an OIG report released Dec. 18. Billing errors in the 13 claims resulted in the hospital receiving $57,800 in over- payments during the audit period of Jan. 1, 2016, to Dec. 31, 2017, according to the OIG. Extrapolating from the 100-claim sample, the OIG estimates that Providence Medical Center received overpayments of at least $325,241 for the audit period. The OIG provided several recommendations to the hospital, including that it refunds Medicare $325,241, identifies and returns any additional overpay- ments, and strengthens its policies and procedures to ensure compliance with Medicare billing requirements in the future. In comments attached to the draft report, the hospital disagreed with all of the OIG's findings and first two recommendations. Despite the objections, the OIG maintained its findings and all its recommen- dations. n

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