County looks to train KCNH staff to process bills

April 24--GALESBURG -- Following years' worth of payment processing errors at the Knox County Nursing Home, the Knox County Board plans to train some of the nursing home's staff members in how to correctly file insurance claims.

At its meeting at 6 p.m. Wednesday, the board will consider whether or not to approve training for Nursing Home Administrator Rachel Secrist and business office manager Jori Shull, as well as other employees. The 12- to 16-hour training would cost between $1,140 and $1,615 and would include topics such as "managed Medicare basics," "PPS basics," "auditing accounts" and more, according to a board packet.

Wipfli LLP, the county's auditor, will host the training along with Wisconsin-based SNF Solutions. Wipfli recommended the training because the nursing home currently has $1.2 million in outstanding bills from insurance claims for individual patients dating back to 2013. The $1.2 million includes claims for Medicaid, Medicare, private insurance companies and Medicaid-Medicare Alignment Initiative insurance companies, Secrist said.

The bills racked up due to processing errors. Over the years, Shull would submit an insurance claim for a service for patients, and the state of Illinois would send it back and say there had been an error. In some cases, Shull submitted a different code than what the state used for that service or that patient. For example, a code she provided might match the service rendered but not the age of the individual, so a different code would be needed. In other cases, Shull would submit a code the state decided not to use anymore simply because a new policy caused it to change.

"They do tell us that there is a error in the claim submission, but depending on the insurance company it's not 100 percent (clear) what that error is," Secrist said. "So at times it's a series of trial and error, ruling out what caused the denial of the claim."

The state would not process subsequent claims for the same patients until the initial claims submitted had been corrected, resulting in a backlog. Secrist said the nursing home resubmitted many of the claims "multiple times." The nursing home also called the insurance companies and sent them faxes multiple times in an attempt to get them to pay, she said.

"With the MMAI program we went as far as contacting our state legislators and holding meetings to gain assistance," Secrist said. "Some of the legislators helped us get paid from the state side on some of our Medicaid claims, but we didn't receive any further payments from the MMAI companies."

Knox County Board Nursing Home Committee Chairman Bob Bondi, R-District 2, said the board thought Shull and Secrist had the required level of skills to be able to process the bills correctly when they were hired. He believed both Shull and Secrist tried their best to correct the problem, and that Shull reacted to "every rejected invoice each time it occurred."

The board, however, did not find out about the $1.2 million in outstanding bills until this year, after auditor Wipfli LLP reported some of its findings from an audit of the nursing home that the board requested.

"I don't think we were probably presented with the receivable information as accurately as we should have been," Bondi said.

Randy Lynch, AFSCME Council 31 representative for nursing home employees, believed that had the $1.2 million been processed correctly, the union could have negotiated for higher salaries to attract more employees to the nursing home. The union can only negotiate with information it receives from the employer, and the nursing home's staff said it did not have money for raises throughout the process, Lynch said.

While Lynch believed Secrist "should have been qualified and should have known how to do all this," he also criticized the board's "nonchalant attitude" toward the situation.

"I don't think the board is doing enough to prevent this from happening again in the future," Lynch said.

Board President Pam Davidson, D-District 3, said the board is working to correct the issue. A committee will be formed at the nursing home to meet weekly and oversee the billing process, Bondi said.

When asked why the County Board didn't know about the outstanding bills sooner, Davidson responded, "We've never really known; how could we know?"

"As a County Board, we don't know about billing," Davidson said. "We don't know; the treasurer's department wouldn't know. We just know if the numbers are coming in and if the money's being paid."

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