Photo: Halfpoint Images/Getty Images
UnitedHealthcare is adding Alabama, Arkansas, Kentucky, Virginia and West Virginia to its Rural Payment Acceleration Pilot, which launched earlier this year.
The plan to expand the program to about 1,500 rural hospitals and associated practitioners, including all Critical Access Hospitals, addresses payments made through Medicaid and fully insured commercial plans.
WHY IT MATTERS
Rural hospitals with smaller populations often struggle to generate revenue to pay for their fixed operating costs.
But those involved in the pilot saw their cash flow and financial sustainability improve with Medicare Advantage payments accelerated from fewer than 30 days to fewer than 15 days on average, UnitedHealthcare said in its announcement on Monday.
The expanded pilot aims to keep more essential facilities open to bolster access to healthcare in remote areas.
In addition to speeding up reimbursements, the expanded program could also help reduce administrative burdens through prior authorization exemptions for most requirements – though UnitedHealthcare did not specify which patient services would be exempt from prior authorization in its announcement.
The payer said it is also partnering with health systems to support hub-and-spoke care models that connect regional clinical expertise with community-based access points through mobile and virtual care, data interoperability and analytics, clinical decision support and home-based care.
Initial focus care areas could include maternity, diabetes and post-surgical care, the payer said.
"We appreciate UnitedHealthcare's efforts to ease the financial and administrative strain being felt by rural healthcare providers," said Alan Morgan, National Rural Health Association's chief executive officer.
THE LARGER TREND
In January, UnitedHealthcare launched its initial six-month Rural Payment Acceleration Pilot in Oklahoma, Idaho, Minnesota and Missouri.
At the same time, some requirements under the Centers for Medicare and Medicaid Services Interoperability and Prior Authorization Final Rule went into effect, including a new timeline for prior authorization approvals.
The rule mandates 72 hours for urgent requests and seven days for standard requests for payers who offer Medicare Advantage, Medicaid, Children's Health Insurance Program and Affordable Care Act marketplace plans.
Payers reported three challenges to compliance, according to a Workgroup for Electronic Data Interchange survey released last year.
At the start of 2027, payers must comply with application programming interface mandates for patient and provider data access.
"With a little more than a year before the compliance date, it is concerning that 43% of payers and 47% of providers have not begun their implementation process," Robert Tennant, WEDI executive director, said in a statement at the time.
ON THE RECORD
"We welcome the chance to make meaningful investments to support their work – and we expect to continue investing more," Tim Noel, UnitedHealthcare's CEO, said in a statement.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
