Billing Problems Continue To Plague Pocahontas Memorial Hospital

Marlinton, WV – At the January 27, 2011 meeting of the Board of Directors of the Pocahontas County Memorial Hospital the financial situation of the Hospital was discussed at length.

Although the Hospital is still in the red, a number of new Policies and procedures, as well as a shift to a new billing service are beginning to show improvements in the Hospital’s financial picture. The hospital finished December with a net loss of $131,000. In partial explanation, several invoices and other bills were actually from November but had to be posted to December. And reimbursements typically slow down during the holiday period.

New policies and upcoming changes should contribute to a vast improvement. The new Quad X electronic billing system will ensure that bills are correct before they go out and should improve turn around time. A New Billing service will also improve reimbursements. One Issue with the old service, Century HMS, is Blue Cross/Blue Shield. Blue Cross/Blue Shield is an electronic billing only entity and does not accept paper billing. As Century HMS submitted paper bills to Blue Cross, those bills went unpaid. An attempt will be made to refile everything from the past six months but anything older than that will have to be written off for timely filing.

Another new procedure is ensuring proper charging. Great deals of goods were simply not being billed. Things such as supplies and medications were often not being charged to patient accounts and therefore, no reimbursement was forthcoming. In one instance with Respiratory Therapy, $23,000 was not charged during a 5 week period due to a misunderstanding of the billing system.

90 days down the road the hospital expects to see an increase in charges, an increase in cash receipts and a reduction in bad debt. All leading to a better balance sheet in the future. The Board approved writing off 159 patient accounts totaling over $116,000 as bad debt and transferring the accounts to a collection agency. They then approved the Financial Report.

Barbra Lay, Interim CEO discussed the hospital seeking Rural Health Clinic status. This designation would improve reimbursement rates but will require a waiver from the Governor. Normally, a hospital must be in a “medically underserved area”. Because of the ratio of doctors to resident population, Pocahontas County technically doesn’t fall into that category. However, with the inclusion of the one million people a year who visit for recreational purposes such status is possible.

The Board discussed applying for a Health Resource Services Administration (or HRSA) grant. This $80,000 grant would fund a study to see if it can qualify as a Federally Qualified Health Center. Such status would improve reimbursement rates, allow for applying for grants to pay for Uncompensated Care and has student loan forgiveness provisions that will enhance recruiting medical professionals. The Board approved moving forward in the HRSA grant application process.

In other business the board approved changing the Medical Director from Dr Pilney to Dr Salmassi. They also gave conditional approval to change the name of the ambulance service pending confirmation of the cost involved including potential for a lapse in reimbursement.