Brock Slabach

Relief is the best word to describe the reactions from the rural hospital community in relation to the Feb. 21 announcement by the Centers for Medicare & Medicaid Services (CMS) that recovery auditors will stop requesting medical records.

Brock Slabach, vice president of the National Rural Hospital Association (NRHA), joined the March 3 Monitor Monday broadcast and shared the overall reaction of rural hospital leaders and staff in addition to several worrisome challenges ahead.

“NRHA was pleased to hear the decision by CMS to delay the implementation of the program,” he said. “We feel that the challenges that rural hospitals have in many different areas lead to disproportionate burdens on our facilities, and these burdens revolve around several things.”

For rural hospitals as well as non-rural hospitals, fulfilling the RAC’s ADR requests requires time and effort. Processing these requests is “incredibly burdensome” for those who deal with the ADRs and appeals preparation, Slabach noted.

In addition to ever-present cash management problem, there’s the upcoming ICD-10 conversion and meaningful use thresholds, which will also be burdensome for rural hospitals.

“Certainly the reimbursement problems in general that rural hospital have to contend with could lead to a real cataclysm for our facilities,” said Slabach. “The average loss for rural hospital is -7.6 percent … there’s not a lot of margin left to withstand variations in payment for facilities.”

In addition to the fact that cash is tight for critical access hospitals (25 beds or less), PPS hospitals are threatened with the disproportionate share hospital (DSH) reductions that the Affordable Care Act mandated. The Medicare-dependent hospital payment and the low-volume hospital adjustment expire on March 31—less than a month away, and Slabach said that the NRHA is working with Congress to ensure that the program is extended past April 1.

“When we look at the reimbursement cliffs coming up, the news that we are not going to have the RACs intervening with continued processes after February 28 is very, very welcome news to us,” he said. “It’s certainly a silver lining in terms of some of the many grave and pressing problems that we have to face in our rural communities.”

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Janis Oppelt is the editorial director of MedLearn Publishing, a division of Panacea Healthcare Solutions, Inc.

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