Cash-strapped New York hospital's deficit plan includes aggressive denial appeals

A New York hospital seeking $83 million in state funding has filed a financial improvement plan that involves aggressively appealing insurance claims denials and limiting overtime and physician bonuses, Newsday reported April 15. 

East Meadow, N.Y.-based Nassau University Medical Center said in the letter submitted to the New York Department of Health that its plan to appeal more denials could bring in millions of dollars in new revenues, according to the report. 

The hospital said it already cut staff overtime and is reducing what physicians can earn from a $13 million revenue pool that physicians and administrators can access for treating patients, according to the report. Hospital officials also expect to boost revenues after updating medical procedure prices for the first time in more than a decade. The hospital has also severed its relationship with an outside lobbyist. 

NUMC's plan will not be enough to get the hospital back in the black, according to the report. The hospital is projecting deficits would range from $18 million to $67 million in 2027, which is down from a projected shortfall of $78.2 million to $121 million in 2024. 

Richard Kessel, chair of the Nassau Interim Finance Authority, which controls finances for the public hospital and the county, told Newsday that while some progress has been made overall, "The  hospital is still not showing the kind of compliance in full that's necessary to be eligible for further state aid considerations."

On March 1, New York Health Commissioner James McDonald, MD, told the NUMC that it must improve its financial picture to receive the $83 million in emergency funds. Dr. McDonald said the hospital would have to agree to state terms, such as conducting a professional and public search for its next CEO and submitting a detailed five-year plan for improving operations and reducing losses.

NUMC submitted a response on March 25 arguing that it met the requirements for the emergency funds. 

"As stated, implementation of performance enhancing initiatives has already begun, and our goal is to rely on less and less government subsidies year after year," interim president and CEO Megan Ryan said in the March 25 letter. "We have been in contact with [state officials] and continue to provide all requested documents and have been promoting continued transparency" with the state department of health and the Nassau County Interim Finance Authority.

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