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News | Payment Trends

Healthcare News of Note: Healthcare insurers owe hospitals billions of dollars in payments and are putting more patients in a bind with retroactive claim denials, says Kaiser Health News

News | Payment Trends

Healthcare News of Note: Healthcare insurers owe hospitals billions of dollars in payments and are putting more patients in a bind with retroactive claim denials, says Kaiser Health News

  • Two of the nation’s largest health insurance companies are behind on billions of dollars in payments to hospitals and have increased retroactive claims denials, says a new report.
  • Finance leaders are deeply involved in determining how businesses adapt to significant changes in how work gets done — particularly in places where digital and finance intersect, a new survey shows.
  • Along with noticing several worrisome health trends among their patients, clinicians reported an increase in strain among themselves and their staff members as the pandemic showed little sign of abating in mid-August.

Over the last few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.

1. KHN: One of the nation’s largest health insurance companies is way behind on payments to hospitals, and another has increased retroactive claims denials

“Anthem Blue Cross, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims, say hospital officials in multiple states,” states an Oct. 6 report that appeared in Kaiser Health News.

Molly Smith, group vice president at the American Hospital Association (AHA), was quoted in the report as saying: “Anthem, like other big insurers, is using the covid-19 crisis as cover to institute ‘egregious’ policies that harm patients and pinch hospital finances.”

The AHA also noted a spike in retroactive claims denials for emergency department care by the nation’s largest health insurer, UnitedHealthcare, according to KHN.

“Disputes between insurers and hospitals are nothing new,” KHN author Jay Hancock wrote. “But this fight sticks more patients in the middle, worried they’ll have to pay unresolved claims. Hospitals say it is hurting their finances as many cope with covid surges — even after the industry has received tens of billions of dollars in emergency assistance from the federal government.”

Anthem’s input

Hancock quoted Anthem spokesperson Colin Manning as saying in an email: “We recognize there have been some challenges” to making prompt payments caused by claims-processing changes and “a new set of dynamics” amid the pandemic. “We apologize for any delays or inconvenience this may have caused.”

2. CFO responsibilities see growth in digital and investor relations, McKinsey says

“Finance leaders are deeply involved in determining how businesses adapt to significant changes in how work gets done — particularly in places where digital and finance intersect,” according to an Oct. 7 report by McKinsey.

Main areas of CFO responsibility growth

The share of finance leaders who say they are responsible for the companies’ digital activities has more than tripled in five years, from 9% in 2016 to 31% in 2021, according to the report, “Mastering change: the new CFO mandate.”

Investor relations is another focus area where the CFO role experienced significant growth, with 64% of recent survey respondents citing that responsibility compared with 44% in 2016.

Two other areas of business seeing steady growth in CFO oversight are:

  • Board engagement, from 28% to 43%
  • Post-merger integration, from 32% to 43%

“The newest survey results show that in the throes of the pandemic, the CFO’s focus has shifted toward crisis management and away from longer-term responsibilities such as strategic leadership, organizational change, and finance capabilities,” the authors wrote. 

The report reviews several other areas of interest, including a mismatch between the finance activities that currently use digital technology and where it would add the most value (revenue forecasting, cash-flow forecasting and scenario management) according to CFO respondents.

3. More primary care clinicians feeling strain of the pandemic, new Primary Care Collaborative survey indicates

Along with noticing several “worrisome health trends among their patients,” clinicians reported an increase in strain among themselves and their staff members as the pandemic showed little sign of abating, according to the Primary Care Collaborative’s (PCC’s) “Primary Care & COVID-19: Round 30 Survey.”

“This round of the COVID-19 survey of primary care clinicians was fielded as the country was experiencing a growing surge of COVID cases from the delta variant and [as] the mass effort to vaccinate Americans continued,” wrote study authors. “More cases of COVID meant heavy demand on the health system for medical care while also creating a behavioral health burden among patients and stress on clinicians and practices.”

Key findings

Two of the survey’s key findings include:

Worrisome trends among patients

  • 65% of clinician respondents had seen an increase in mental health issues among children (e.g., depression, anxiety, ADHD)
  • 59% had seen fully vaccinated patients who were getting COVID-19
  • 58% were unsure how to help their patients with long-haul COVID-19

The toll on clinicians and staff as the surge looms

  • 67% of clinicians reported a moderate or slightly high (3 or 4 on a 5-point scale) level of strain on their practices in the month before the survey, stemming from COVID-19-related changes and pressures
  • 50% of clinicians said COVID-19 “was again surging in their area and they didn’t know if they could take it”
  • 53% said “the poor mental health of their staff was a constant worry”

Other topics covered

The growing pressures of providing care in the pandemic, the effort required to address vaccine hesitancy, and the continuing demand for vaccines among those who want to be vaccinated are also discussed in the survey.

The survey, a partnership between the PCC and the Larry A. Green Center, was fielded Aug. 13-17 and included input from 1,263 clinicians, including MDs, PAs, NPs, DOs and others.

HFMA bonus content

  • Learn about HFMA’s all-new Premium Facilitated Learning (PFL) content in this Q&A. Register now for the first PFL course, Leveraging Budgeting & Reporting as Strategic Tools, Nov. 15 to Dec. 10.
  • Listen to the latest Voices In Healthcare Finance podcast:  HFMA‘s Healthcare 2030 series: What will the next decade mean for healthcare organizations and the patients they serve? (podbean.com)
  • Register for HFMA’s 2021 Annual Conference, which takes place in-person and digitally, Nov. 8-10 in Minneapolis.

About the Author

Deborah Filipek

is as senior editor with HFMA, Westchester, Ill. 

Sign up for a free guest account and get access to five free articles every month.

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