A former business office manager of Petersburg Medical Center, Ramona Thompson, attended the regular meeting of the Hospital Board Thursday evening to question the processes of the PMC business office.
“In my long experience in hospitals’ practice management, facility bailout consulting work and the revenue cycle, I have seen facilities with far less issues than PMC has, close,” Thompson said. “The PMC business office has been understaffed since the business office manager left in 2011. During 2012 the business office was short staffed at least six months. It takes at least 12 months to resolve a six month back log.”
Thompson explained that many of the issues regarding the business office are because of understaffing and the manner in which information is funneled from one department to the other.
“Current medical services still have to be maintained at the same time,” she stated. “Backlogs are difficult to resolve and are extremely stressful for business office staff. Back logs result in higher error rates since staff is concurrently struggling to resolve backlogs and maintain current accounts. Some of the issues that have surfaced recently are a direct result of inadequate staffing in the business office.”
Thompson also stated that the business office is being used as a scapegoat for a flawed billing system and long-time flawed hospital wide process.
“Inadequate staffing is being used to deflect attention elsewhere,” she stated.
She quoted examples of issues that she reported to both the CEO and CFO that may face PMC in the near future.
“PMC lost $63,000 in 2011 and 2012 by having to write off services they could have billed for because there were no advanced beneficiary notifications, ABN's,” she stated. “ABN's are a federally mandated requirement by Medicare. ABN's notify patients that Medicare may not pay for a service and gives them three options before services are rendered.”
Thompson stated that clinical doctors are ignoring portions of forms requiring these notifications take place.
“$63,000 is a lot of money for PMC to lose,” she stated. “A far greater concern for PMC is the fine for missing one ABN which is $2,000 for each.”
Thompson also explained that PMC could face fines in excess of $100,000 plus penalties and interest based on the number of ABN's that were missed in 2011 and 2012.
She stated another concern is the deficiency of Medicare secondary payer questionnaires, or MSPQ, and the fine for one deficient MSPQ is $10,000.
“PMC had enough missing or deficient MSPQ's in 2011 for a potential $3,140,000.00 Medicare fine plus penalties,” she stated. “When I discussed this with my immediate supervisor CFO Leon Walsh, he advised me that PMC had already received a first warning from Medicare about this.”
Thompson explained that this should be a red flag and PMC could be shut down because of this.
She continued with a list of inaccuracies in charts, missed charges, payments refunded and point of service charges being missed due to incorrect logging.
“Departments are not entering the charges and bringing them down to billers who have to devote precious time to do other departments’ charge entry work,” she stated. “Department managers are bringing their department errors down to the billers and again billers have to devote time to correct other peoples’ mistakes.”
Thompson reported that managers are not holding their own departments responsible for departmental work which has delayed payments and created the opportunity for more errors.
“Before the business office is, once again, held as the sacrificial lamb, it is time that PMC does some serious soul searching,” she stated. “It is obvious that all along it has been the intent to outsource the business office. The business office has worked understaffed in an antiquated system that needed to be updated a long time ago as three new positions upstairs have been created but one additional position in the business office will not even be considered.”
She also explained that one more position in the business office could make all the difference in the world and allowing them a more modern billing system would also help with the deficiencies.
PMC Hospital Board President, Tom Abbott stated that a new billing system, CPSI, is being implemented at this time.
Thompson submitted a written copy of her concerns for the record and stated that she hoped PMC would consider outsourcing the entire hospital.
Petersburg Medical Center CEO, Liz Woodyard was asked to make a response but chose to not comment at this time.