Hospitals are grappling with mounting financial pressure as coverage losses tied to Affordable Care Act marketplace changes and upcoming Medicaid cuts threaten to widen gaps in provider revenue, prompting many systems to lean harder on commercial payors and take a firmer stance in reimbursement disputes. As healthcare organizations navigate a shifting payor mix and persistent regulatory uncertainty, attorneys say providers are increasingly willing to challenge underpayments and hold their ground in contract negotiations rather than concede.
Bracewell’s Carrie Douglas told Law360 the uncertainty is starting to affect the way hospitals think and prepare.
“I think there is a trend towards, ‘We need to stand firm and really push the envelope on these,’” she said, adding that because of the changing payor mix, there are fewer ways to offset costs if they don’t.