TennCare-Paid Claim Losses Climb At Erlanger

Monday, October 23, 2006 - by Judy Frank

It cost Erlanger Health System about $5.3 million to treat TennCare patients during September, but the medical center was reimbursed for just $2.3 million of that total, according to figures released Monday during a meeting of the finance committee of the hospital authority.

The result: Erlanger lost more than $3 million on TennCare claims during that single month.

Since July 1, the start of the current fiscal year, Erlanger has lost $5.1 million in TennCare-paid claims. That’s because it cost the medical center more than $10.1 million to treat TennCare patients, but was reimbursed just
$5 million by the state agency.

Britt Tabor, Erlanger’s chief financial officer, told finance committee members that another $11.7 million in uncompensated care costs since July 1 can be tracked to charity, bad debt, out-of-state Medicaid and outstanding TennCare costs.

Often, a single case results in many thousands of dollars in claim losses, committee members learned.

For example, Erlanger’s cost to provide a craniotomy for multiple significant trauma was more than $100,000, according to figures that Tabor released, but TennCare paid the medical center just $22,000.

Treating a newborn with extreme immaturity or respiratory distress syndrome cost Erlanger more than $50,000, but TennCare reimbursed the medical center just $24,000.

And a premature birth without major problems cost the medical center more than $27,000 – 10 times the $2,700 which TennCare paid.



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