I try to have my articles be educational, with topics that will have broad appeal to our readers in different healthcare settings. So I hope you’ll forgive me for this article, which is on some level arguably totally irrelevant, but I believe utterly riveting.
It involves Provider Relief Fund (PRF) questions, for a program that is over. But I want to tell the story, because I’m hoping to help a small critical access hospital (CAH) – and because the story is crazy enough, I think many of you will find yourselves sharing it with others.
So, a CAH in Montana applied for and received Provider Relief Funds in rounds 1, 2, and 3. It applied for funds in round 4, but the funds never arrived. As explained by someone in an overseas call center, there was a problem with this hospital’s application.
Provider Relief Funds were to be paid only to a hospital. Agents and billing companies weren’t eligible to receive the funds. Now, again, this particular hospital is in Montana. It’s part of the Billings Clinic health system. The hospital name includes a reference to the Billings Clinic. The folks reviewing the application thought that they had astutely detected that the hospital was really a billing company. As they explained, “it’s right there in the name. It says ‘billing clinic.’” (The “s” that they dropped proves rather important.) The person on that phone call was unmoved by the explanation that “Billings” is a city in Montana.
Ultimately, the government contractor processing the application recognized its error. That should have brought a happy ending to this saga and precluded the need for this story. Unfortunately, when the Provider Relief Fund program ended, someone decided that any funds that hadn’t already been paid out would be frozen. The hospital hadn’t yet received the funds, because of the contractor’s mistake. And now they’re being told they will never receive the money.
We’ve talked a number of times about the challenges facing CAHs. The Provider Relief Fund program was designed in part to help them. There’s a pot of money that should be helping this particular hospital, but a well-intentioned but not terribly thoughtful employee of a government contractor may well cost a CAH a quarter of a million dollars.
I’m still hoping common sense will prevail. If anyone reading this works for the contractor that was processing PRF applications who employed the geographically impaired individual who denied the initial application, I am hoping you will help right this wrong.
Alternatively, if you work for the Health Resources and Services Administration (HRSA), perhaps you can help. This miscarriage of justice is so basic that no one should be paying me to solve it.
One of my philosophies is that everything in life is a good time or a good story. The sad truth is that some of the good stories are a bit painful. This is definitely one of those painful stories, but I’m cautiously optimistic that in the end, justice will be done.
On Monitor Mondays I usually end my segment with a song. Songs don’t always translate into an article, but for this situation I can turn to one of the best rock groups of all time. In the words of The Beatles, help, I need somebody. Help, not just anybody. Help me if you can. I’m feeling down.
Whether or not you can help on this one, I most definitely do appreciate you being around. But if you’ve got the power to fix this PRF injustice for a CAH, both my client and I will appreciate you a bit more.
Among the many responsibilities of hospital case managers, none is more critical or more impactful than the initial discharge planning evaluation. Often referred to as
As alluded to on Monitor Mondays, Dr. Ronald Hirsch and I have been enjoying our fall lattes while combing through the Centers for Medicare &
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