Karen Brown came to Heart of the Rockies Regional Medical Center in Salida, Colo., in January as the hospital’s new revenue cycle director, bringing more than a decade of revenue cycle experience in North Dakota and Indiana to a Colorado community she was still learning. What she found was a critical access hospital mid-implementation on Epic, serving a retirement-heavy rural population and heading into one of the most consequential regulatory periods in recent memory.
The first pressure is already at the front desk. HRMC serves a large retirement community, and many patients arrive having relocated from other states with Medicare Advantage plans the hospital is not contracted with. They often don’t understand why their costs are high or why the hospital can’t accept their coverage.
“They’ve come from other places, and they have these Medicare Advantage Plans that we are not networked with,” Ms. Brown said. “So then they don’t understand why we can’t see them, why their bill’s so high, and they just don’t understand. They get really good healthcare, but then when it comes to the billing.”
The billing infrastructure had long been largely manual — a gap the Epic implementation is specifically designed to close. In the meantime, Ms. Brown and her team are working to educate patients at the point of service: explaining their insurance, walking them through what is and isn’t covered and offering a robust self-pay plan for patients whose coverage doesn’t work at HRMC.
The second pressure is regulatory and arriving on a compressed timeline. Colorado is implementing a series of eligibility changes under new federal legislation. Beginning this fall, the state will enforce stricter immigration eligibility rules for Medicaid, followed by work requirements and a six-month eligibility window for Medicaid enrollees starting in January. Those changes will expand the pool of uninsured and underinsured patients arriving at the hospital and require additional financial counseling, insurance verification and charity care discussions. Rural hospitals across the country are preparing for similar coverage gaps as Medicaid eligibility rules tighten nationwide.
Colorado also operates a hospital discount care program — referred to internally as the HDC — that allows the hospital to provide free care to qualifying patients without state reimbursement to offset the cost.
“We just give away care,” Ms. Brown said. “But we do that so that our patients could have what they need.”
The loss of certain rural supplemental payments starting in January 2027 adds another layer. HRMC operates six clinics offering rehabilitation, cardiology, oncology, urology and surgical services, a breadth uncommon for a critical access facility, and protecting that service array requires revenue cycle operations that can absorb additional financial pressure without compromising access.
The compound exposure has pushed Ms. Brown toward a strategy built around improving upfront collections, ensuring accurate registration and reducing avoidable denials.
“My focus is going to be making sure our team is educated, our workflows are efficient, and we are proactive in helping our patients navigate these changes while protecting their financial health at HRMC,” she said.
She is extending that approach beyond the hospital walls. Building community partnerships with local employers and organizations, getting patients thinking about their financial options before they ever register, is central to her longer-term plan.
“I want to strengthen the partnership with our local organizations, employers, and community groups, to increase awareness and improve access to care, to help our patients understand their financial options before they receive services,” she said.
Internally, she is working to build tighter alignment between clinical and administrative departments, with the goal of creating a more seamless patient experience from registration through billing and collections.
“I want to continue to build a collaborative relationship across all of our departments where we can work together to remove any barriers for our patients and create a more seamless experience when registering and from registration all the way through billing,” Ms. Brown said.
The Epic build has consumed much of her first year — Ms. Brown arrived just as the implementation was beginning — and she said she is proud of how the team navigated the transition without breaking stride on daily patient care. The harder work, she said, is still ahead.
“It’s a whirlwind right now in a revenue cycle world for critical access hospitals,” Ms. Brown said.
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