CCHS is maintaining a positive financial bottom line

DAYTON—The Columbia County Health System is planning on a large Medicare take-back payment of around $1.15 million, which is not particularly unusual since the Centers for Medicare and Medicaid Services (CMS) operate on a cost-based reimbursement model. That is to say they front load money for patient care every year, based on the previous year’s data, and they can either collect the amount they overpay or make additional payments, if they underpay.

It could be a “wash” if CCHS manages to collect what it is owed from three different Medicaid managed care plans, according to CCHS Controller Tom Meyers, who spoke at the Hospital Board of Commissioners’ meeting last week.

CEO Shane McGuire said CCHS has been grossly underpaid by Medicaid for swing bed patients since 2015, and Molina is the largest offender with underpayments approaching $850,000.00.

“They have agreed that they have underpaid us, and we have been working on a way to settle the outstanding balance,” he said.

Amerigroup owes CCHS another $63,761 and Coordinated Care has an underpayment of roughly $200,000.00, he said.

McGuire told the commissioners last week that Molina made an initial $200,000 offer to CCHS, which was “politely” refused, in favor of collecting the total amount owed.

“We still have work to do with the other two Medicaid managed care organizations to settle the nearly $270,000 outstanding,” McGuire said.

“All of the payers have been very willing and open to working with us on finding solutions. We don’t feel that they are trying to deny responsibility,” McGuire said.

McGuire said their organization will have a better idea about the actual amount of the take-back payment owed to CMS after an interim cost report is completed, sometime in March or April, 2020.

At that time CCHS will be required to pay the amount due, or allow CMS to withhold payments from the hospital until the amount due is repaid.

In September, $775,000 had been booked by CCHS in anticipation of the need to submit the interim report to the CMS.

“Even with this booking, we are still maintaining a positive bottom line,” McGuire said. “We’re controlling costs and getting more efficient.”

There has also been some growth in additional operating revenue not directly tied to care for specific patients, Tom Meyers reported to the commissioners last week.

CCHS has received funding from three categories of program revenue which reflect new ways of being paid. The National Rural Accountable Communities Organization, Washington Rural Hospital participation, and Greater Columbia Accountable Communities of Health (GCACH), all contribute to profitability, Tom Meyers said in his report to the commissioners.

CCHS should receive about $600,000 before the end of the year through GCACH, Meyers said.

In addition, CCHS received almost $100,000 from the state Health Care Authority/Medicaid for 2010-2011 for electronic health records conversion reimbursement. Meyers said it is a pleasant surprise to receive these “lost” funds.