In mid-March, King of Prussia, Pa.-based Universal Health Services named Michael Coffey CFO of its Phoenix-based Valley Hospital, a private psychiatric hospital that specializes in chemical and mental dependency care.
Along with cutting costs, Mr. Coffey told Becker’s that, in his new role, he is zeroing in on a behavioral health industry challenge: fraudulent enrollment in ACA exchange plans. He said over the last six to eight months, some patients had been incorrectly signed up for exchange plans, which created a conflict between Medicaid and commercial insurers over payment responsibility.
“We have this back and forth between the two plans on who is going to pay us,” he said. “Insurance companies [will] pay you for what they owe you, but they’re looking for details. If they can find a reason that you did not follow the procedures correctly, they’re going to look for reasons why they can deny payment to you.”
To combat this, Valley Hospital has started “double- and triple-checking” patient eligibility and Medicaid plans to ensure nothing has changed.
“It’s something that we are all trying to find ways to locally handle, [to] find resources that can help us figure out what plans the patient should be on and to get that corrected so that everybody can be reimbursed properly,” Mr. Coffey said.
Mr. Coffey has also been watching for potential policy changes tied to Medicaid funding. However, he and his team are being told there will be no changes to the funding.
“Of course, with two things going on: the budget process is going on with Congress, and things coming out of the White House on potential changes with how they are going to fund things,” he said. “Those two things we have to pay attention [to] to see how it’s going to affect the Medicaid population. We are definitely keeping an eye on it every day.”
