At the Feb. 23 meeting, Eureka Springs Hospital CEO Tiffany Means covered the revenue cycle of the hospital from patient registration to billing. Means told commissioners the cycle was the most fragmented she had seen, and any portion of the process that requires them to backtrack on gathering information leads to a lengthened time before money comes back to the hospital.
Means’ income breakdown includes gathering of patient information, clinical documentation, charge capture, coding and review, and claims submission. In fixing the splintered process leading to claims submission, Means said that staff had been undergoing training on gathering patient insurance information, as well adding new processes to make sure that clinical charts were reviewed and providers properly queried to clarify diagnoses to make sure they were translated to a billable code.
Velvet Shoults, the hospital’s clinical nurse executive, clarified that when billing for medical services, the example of “shortness of breath” is not an appropriate end diagnosis as it is too broad and vague. She said that staff at the hospital would be used to being “queried” in other locations and having providers clarify documentation more thoroughly would lead to a better standard of care.
Regarding charge capture, Means noted that the most trouble the hospital has had in the past is billing of professional fees. She said that within the last month she had noticed a patient’s bill had failed to include them, and after diving deeper she found the hospital had been failing to collect on these fees for a year, leading to an estimated $800,000 loss.
Means explained that staff providers had not been properly credentialed to collect on these fees and each provider must be credentialed with each separate insurance company. Means said HR Director Jodi Edmondson is working on getting each provider properly credentialed and notifying each insurance company.
Commissioner Bryan Beyler asked if a patient were to come in “tomorrow” and see a provider not credentialed with their insurance “Are we hung out to dry right now?” Means said yes, reiterating the hospital is remedying that. The commission also asked if there was any way to recover the $800,000 and Means explained the hospital can only go back so far before they can no longer bill those professional fees.
On coding and review and charge capture, Means said that claims are submitted electronically and are checked “in the scrub” if the claims are “clean.” Software reviews medical claims for errors, omissions, and inconsistencies before being sent out to the insurance payers, and she said that if those claims are not done properly they get held back.
Means said that at the start of January, there was the equivalent of $3.3 million dollars held up in billing claims and that a contract staff that she hired as experts in these billing claims had dropped that amount in the past weeks to just over $1 million. Means clarified that amount is not necessarily what the hospital will receive back, it is just the full charges that have been submitted.
She said that patients have called on several occasions about insurance information being incorrect or not receiving any bills, and these issues are why the revenue cycle needs to be an efficient and clean process. Means also noted an issue with billing coming from Oracle’s side of the operation and that they had failed to provide information, saying it was difficult to speak with a real person rather than an automated service. She said she’d filed a grievance with the company on the issue.
The end of the meeting was lighter with mention of the facility flooring put in and specialty clinics being prepped in the hospital as well as outpatient infusion services being available. Means also mentioned the Feb. 11 Coffee with the CEO was well attended and that she would hold one monthly so the public could come and speak with her directly about the hospital.
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