Revenue Management Expert Evaluates Contract Dispute

    Healthcare Expert WitnessThis case involves an alleged failure to compensate the plaintiffs for a shortfall in a healthcare revenue management contract despite previous explicit agreements. The law requires that hospitals like that of the plaintiff provide indigent care to persons who do not have health insurance, and who are not eligible for other health care coverage. There are specific quotas for treatment of indigent patients; if a hospital exceeds its minimum obligation it can seek reimbursement from the country for this excess. If the hospital falls short of the minimum obligation, this law empowers the state to assess the shortage against the hospital and demand payment to cure it. The plaintiff in this case had hired the defendant healthcare revenue management firm to assist in conducting eligibility screening for patients, and ensuring that applications for such government assistance were timely submitted and complete. As part of this contractual agreement, defendant assumed responsibility for any dollar difference between county indigent obligations and the actual amount. At the conclusion of the first fiscal year under contract, the defendant firm allegedly failed to achieve revenue goals with several million dollars in shortfall.

    Question(s) For Expert Witness

    • 1. Please briefly describe your experience as it relates to healthcare revenue management.
    • 2. Can you speak to Medicaid / Medicare / indigent care qualifications and eligibility?

    Expert Witness Response E-125625

    I teach and work with the case management staff at a hospital to work with the financial assistant team. The Financial counselor may be an internal employee of the hospital or in some cases, such function is outsourced to a third party private company who provides their expertise and service to help the patient and the hospital. Medicare rules are Federally guided rules. Medicaid rules of financial aid are set by the state. An indigent who does not qualify for any financial assistance and does not have insurance and resources to pay for the care are usually asked to apply for the hospital payment plan. Hospital uses their own guidelines to qualify the patients. The common theme is around the poverty line set at the Federal govt. level and others use it define how much income or % of the federal guidelines they would use to decide if the person gets the financial aid or does not to keep thing simple at the time of writing this. I either have to look up the contract to see what we can expect or we ask for the summary of expectations.

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