Cost/Containment collects thoughts on collecting cash | Eastern North Carolina Now

    At the onset of yesterday’s Beaufort Regional Health Systems Cost/Containment Committee meeting, the panel approved a contract between the hospital and BCE Technology of Clearwater, Fla., for their Clinical Documentation Improvement Program, which is expected to generate revenue by more-appropriately coding patient charts. The BRHS Authority Board of Commissioners will vote, by telephone, on the contract before it is presented to BCE Technology. The hospital board voted on July 27 to “empower the CEO to proceed with engaging this company”; therefore, the contract is predicted to pass, as well.

    Concerns regarding methods for transitioning increased revenue into cash, or ‘collection options’, led to a confusing exchange between Cost/Containment Committee members and BRHS Chief Financial Officer Chris Riggs. On July 27, Riggs and BRHS commissioner, Cost/Containment Committee Chair Hood Richardson separately estimated the Clinical Documentation Improvement Program’s revenue potential at $1.7 million and $1 million, respectively. BRHS commissioner and Cost/Containment Committee member Jack Piland was the first to point out that revenue doesn’t always yield cash.

Chris Riggs and Jack Piland at Monday's Cost/Containment Committee meeting.

    “People may not have any money. And so, we’ve got really elaborate charts, but we didn’t collect any money,” warned Piland. “So, that’s what I’m concerned about, is that if we pay then we need to be getting.”

    BRHS Authority Board Chair and Cost/Containment Committee member Alice Mills Sadler matched Piland’s concern about the reality of the projected revenue increase.

    “That’s a very good point, because our next step after coding is collecting, because we know that there’s also a problem with collecting,” she said.

    Richardson, agreed that “revenue is not billing.” He said the hospital needs to take an aggressive stance on collections, similar to that of Martin General Hospital in Williamston, to make sure people are fully aware that they are expected, by Beaufort Regional Health Systems, to pay what they owe.

    “This has a lot to do with community perception. The community perception in the past has been that if you couldn’t pay, you didn’t have to pay,” he said. “The perception in Beaufort County is, don’t worry about it, you don’t have to. And we’ve got to change it.”

Hood Richardson at Monday's Cost/Containment Committee meeting.

    This is where it gets confusing.

    The Cost/Containment Committee began discussing whether or not the hospital should hire Healthcare Fiscal Management of Williamston to help them with collections. Richardson, Piland and Sadler first asked CFO Riggs to paint a picture of the current collections landscape.

    “There are different pieces of it,” explained Riggs. “We’re using some different entities to do different things. We do have a group that’s going back and looking some at old accounts…We probably engaged them eight weeks ago.”

    Richardson and Sadler both asked if Healthcare Fiscal Management would be duplicating collection services. “Does it look like there’s an opportunity for these people to do something for us, or are they shut out because we’ve already got the waterfront covered?” asked Richardson.

    “Are we going to have two people doing the same thing?” asked Sadler.

    As if they Richardson and Sadler were suggesting that the duplication of services might be a possible goal, Riggs responded, “Personally, I don’t think it’s necessary to do that.” Therefore, the question about ‘duplication of services’ was never answered. Riggs could not be reached today for an explanation. Along another vein, Riggs insinuated that Healthcare Fiscal Management would attempt to collect debt from all self-pay patients (people who don’t qualify for Medicaid, who aren’t insured) almost directly after their service dates, thus taking a 16-percent collections fee even for those patients who would have paid in a timely manner.

    “Very early in the process, as soon as we screen them for Medicaid and determine they’re not Medicaid eligible, then they go to this company and they start working within, I’m going to say, two weeks from the time the patient is discharged,” said Riggs. This is not the role Cost/Containment members were expecting Healthcare Fiscal Management might take.

    Piland asked for clarification: “So, even if the person was going to pay, these people are in the loop and would pick up 16 percent of it?”

    Riggs responded: “No, I wouldn’t piggyback this on top of that.”

    Piland rephrased his question, in hopes of getting a straight answer: “Do they get a chance to pay the hospital all of it, rather than 84 percent of it?

    Rather than answer the question, Riggs gave figures on the extraordinarily low percentage the hospital recoups on bills sent to self-pay patients. While these figures explain the hospital’s need for a collections agency, they don’t address at what point in the billing process the agency would begin its collection procedures.

    “Past experience has been, on the uninsured patients, that we were getting a very, very small percentage,” he said. “We’d send them three statements, and we would collect a very small percent—2 to 3 percent I think is the figure.”

    Sadler attempted to elucidate the Cost/Containment Committee members’ questioning of what had seemed before to be a fail-safe collections program. She reminded Riggs that earlier he had presented Healthcare Fiscal Management as a last resort for collecting delinquent bills, rather than as a mechanism for collecting all self-pay bills almost as soon as they leave the door.

    “You were talking about very likely that these people were going to go after accounts that weren’t being paid. And you would choose the ones that we were going to hand over to them to collect for us,” she said. “Now it appears that everybody, like Jack says, is going to go to these people, and instead of us getting all of whatever, we’re only going to get 84 percent of what we would have gotten. That doesn’t make sense, even to me.”

    Riggs responded: “We’re using two companies right now that are working those accounts. It’s just like a collection agency, but they’re getting the accounts very early in the process.”

    Sadler recommended that they end the discussion about Healthcare Fiscal Management until Riggs can assemble information about hospital collections and present it to the Cost/Contianment Committee in a clear manner.

    “Let’s unravel the tangle so that we have some kind of alignment we can follow, the tangle of how collection works,” said Sadler. “Because right now we can’t have an intelligent conversation on how it works, and that’s not good.”

    Richardson agreed, adding that, by Friday, Riggs will have received the final proposal from Healthcare Fiscal Management that would more specifically lay out its intentions.

    “If we could have a flow chart for Friday’s meeting, that would be great,” he said. “Then, we’ll have their proposal, and you’ll be able to recommend how you want to proceed.”

    Friday’s Cost/Containment Committee meeting will not be open to the public, as they are closing it to discuss “personnel” matters.