If you bill it, they might pay -Some PMH services not billed-
Pocahontas Memorial Hospital has provided a lot of services for patients in the area, but charges for some of those services have fallen into a black hole.
At last Thursday's board meeting, Interim CEO Barbara Lay told the board that some long-time hospital employees told her that they didn't think charges for supplies and pharmacy were "going anywhere."
They were right.
A sampling of inpatient charges for the months of July, September and December showed that the average daily charge for 2009 was $1,129.ﾠ For 2010, that amount increased to only $1,136.
A similar review of Minnie Hamilton Healthcare' s inpatient accounts showed an average daily charge of $2,180.
That $1,000 per day difference for 3,435 average inpatient days adds up to $3.6 million, Lay told the board.
In addition, Lay said a review of Our Ambulance revealed that pharmacy charges for that operation have never been billed.
"We are working hard this month to make sure that we are capturing that," Lay said. "We have great people, who are working hard to bring about changes."
CFO Chad Carpenter reported that Respiratory Supervisor Dean Gunter was concerned that his charges were not making it through the system.
Carpenter told the board that Gunter felt the "processes were broken."
That statement also proved to be true after Gunter comprared procedures with Greenbrier Valley Medical Center.
Gunter looked at charges for PMH's respiratory department for a five-week period and reported that, in aerosol treatments alone, there were missed charges in the amount of $23,000.
"It is a learning in progress," Carpenter said.
Director of Nursing Stephanie Alexander is looking at every ER and ambulance bill on a daily basis now.
"We are developing a process to check up to see if the charges are being captured," said Alexander.
To assist in capturing charges in all areas, the hospital has implemented a sticker system.ﾠ Every supply has a sticker, and when used, that sticker is attached to the appropriate chart.
"Ninety days down the road, do we see increases?" asked board president Dr. Robert Must.
"Increase in receipts and decrease in bad debts," Lay responded.
"We had taken for granted that people could read an EOB, [Explanation of Benefits]. But they had never learned," she said.
The hospital showed a loss of $131,000 for the period ending December 31, 2010.
Board member Donald McNeel noted that cash receipts were down for the month of December.
"Is January looking better?" he asked.
Receipts for December and January usually lag behind, Carpenter told the board.
In addition, Lay told the board that Medicare had changed the format for the way bills were submitted.
"Everyone changed, but the Medicare system wouldn't work," she said.
Medicare hopes to have the problem fixed by February 3.
Employees in the business office will soon be using the Quadex billing system to improve the accuracy and timeliness of the process.ﾠQuadex identifies errors before bills leave the billing office making for a quicker turn-around time in accounts receivable.
Former billing company HMS was not getting the billing out, Carpenter told the board.
HMS was sending paper bills to Blue Cross-Blue Shield, which only accepts electronic billing.
Staff reported that there is no way to collect outstanding accounts that are more than six-months-old.
PMH subsidiaries show losses
Our Ambulance showed a loss of $23,251 for the month of December.
"How many ambulances do we have?" McNeel asked.
There are three in service and one out of service, yet the hospital is renting four life pacs.
Carpenter noted that, presently, the hospital should only be renting two.
A proposal to change the name of Our Ambulance to PMH Ambulance was tabled until costs could be ascertained.
Lay told the board that it was important that the ambulances, when traveling out of county, be recognized as a part of PMH.
PMH Clinic showed a loss for December in the amount of $33,122.
A reduction in office visits and a change in charge-offs was reported to be the reason for that loss.
Despite the hospital's plea to the public, only $1,600 has been received on old accounts.
Carpenter reported that write-offs and exonerations in excess of $116,000 for 159 patient accounts are ready to be written off and sent to the hospital's collection agency.
"The collection agency can reach out farther than we do," said Lay.
To give a clear picture of how these accounts affect the hospital's finances, a line item for Provision For Bad Debts has been added to the income statement.ﾠ That amount now stands at $420,863.
Efforts are underway to establish the hospital as a FQHC, Federally Qualified Health Center.
In return for serving all patients regardless of ability to pay, FQHCs receive consideration from the federal government in the form of a cash grant and cost-based reimbursement for Medicaid patients.
There is also a provision to assist providers with student loan repayment, Lay said.
"We could not get FQHC before, we are not underserved," said Must.
To become a FQHC, 50 percent of board members must be users of the services provided by PHM and PMH must have support from other FQHCs in the area. In addition such status will require a more extensive audit.
The hospital has the appropriate IRS letter, Lay said, but must get waivers and meet other criteria.
Due to its location and the number of tourists who visit the county each year, Lay told the board that PMH could be considered a Safety Net provider.
Lay informed the board of other plans and changes that are in process.
ﾷ Dr. James Mical Jarrett submitted his resignation, effective 90 days from January 11.
ﾷ Dr. Jeffrey McCray will serve as Chief of Staff.
ﾷ Administration is seeking Rural Health Clinic designation for the hospital to increase reimbursements.
ﾷ Increased efforts to market the hospital and its services including spots on local radio WVMR
ﾷ Implementation of an Employee Work Life program which looks for ways to improve employee morale
The next scheduled board meeting will be Thursday, February 24, in the hospital conference room.