Wow John,
You are confirming some of my worse fears about this. I have a good relationship with my little hospital, but I just don't like the idea of even another layer of bureaucracy coming between me and the reimbursement (and the ability to provide quality care).
I am pretty ocd about records in my hospital that still uses paper charts. At times a signature is needed for this or that, and doesn't get done because it is in someone else's box. I don't have any way of knowing until I get a "nasty gram". I can see this being another reason for not paying.
The only good thing I can think of is that maybe the hospital would still have to pay us if the patient hadn't met deductible.