Payments delayed to RMC; software changes, Medicaid hold up hospital’s money

March 09--Payments are being delayed to the Regional Medical Center due to a backlog in the state's Medicaid eligibility applications and a computer software issue.

RMC has about $21 million in accounts receivables outstanding through the end of February.

"This does not mean we lost this money," RMC Chief Financial Officer Liza Porterfield told trustees last week. "This just means there is a delay to get the claims out and processed and getting paid.

"It is not that the claim will not get paid. We will get paid."

The hospital's accounts receivable days for the month of January was 58 days. Accounts receivable days refers to the number of days that a customer invoice is outstanding before it is collected.

The delay can be blamed on an annual software update for the hospital's clinical encoding software.

"Every January we have issues with getting that updated, so that delayed our ability to get claims processed and out the door to our payers," Porterfield said. "It was an eight AR day impact for us of about $11 million of accounts receivables."

Porterfield said the delays have since been resolved, with the claims going out in the month of February.

"We expect this to have a 30 to 60-day delay in us getting the claims paid from the insurance company," she said.

Trustee Milton Dufford asked if this is a statewide problem.

"What we have discussed in the finance committee was putting things in place to be more proactive to manage these updates," Porterfield said. "My understanding is maybe were not quite as proactive to make sure those were tested and entered into our system timely."

The RMC also has about $10 million in pending Medicaid dollars due from the S.C. Department of Health and Human Services.

The SCHHS changed its Medicaid eligibility system a few years ago and has seen a backlog of applications.

About $10 million in Medicaid charges are tied up in Medicaid applications, Porterfield said. Normally the backlog runs about $6 million.

"We are seeing a bottleneck there with that vendor who processes those authorizations. They have a four-week backlog there," Porterfield said.

Porterfield said some of the claims are over a year old and are "aging out," or being denied for timely filing. Each one then has to be individually submitted for reconsideration.

The S.C. Hospital Association has requested the state waive the reconsideration process and put something in place to review a group at one time.

Dr. Frank Coulter, chairman of the Medical Staff Executive Committee, questioned why the hospital is having to suffer for something that is the fault of the state's Medicaid office.

"Is there a way we can approach them saying when we have an eligibility problem and we are a year out getting eligible, shouldn't we have an extension on filing a claim?" Coulter said. "It is creating more work for you."

Porterfield said Medicaid, "has not yet been willing to change the process."

In other matters:

--RMC saw a total loss for the month of January of $263,669.

"Volume was off and that impacted revenue big time," Finance Committee Chairman Kenneth Rickenbaker said.

Porterfield described the month as a "mixed bag" for volumes.

"We have had many patients come through our emergency room and were subsequently admitted to the hospital," Porterfield said.

Porterfield said the hospital had about 81 contract workers, which costs the hospital more than regular employees. She said there continues to be an effort to phase out contract employees to save money.

Year-to-date, the hospital has seen a loss of $3.1 million.

Taking into consideration the hospital's family practices, the total loss for the month of January was $585,000. The total loss for the system year-to-date was $3.7 million.

"Although we experienced a loss, there is a marked improvement. That means we are tracking in the right direction," RMC Chair the Rev. Dr. Caesar Richburg said.

--The hospital received a refund check of $147,515 from the Palmetto Hospital Trust. The trust administers the workers' compensation program for the hospital.

Refunds are based on the hospital's participation in the trust and claims made. The hospital receives a refund when certain benchmarks in employee safety are made.

A total of 67 claims were filed in 2017.

Half of the worker compensation claims covered employees being struck or injured by an object.

About 21 percent of the claims were made by employees injured by people, including patient aggression.

About 19 slip, trip and fall injuries were reported in 2017.

--Trustees unanimously approved a photography/videotaping/audio recording policy for the hospital.

The purpose of the policy is to provide guidance and organizational support to employees, medical staff members and volunteers who do not consent to being photographed or recorded by patients, family members, visitors and private sitters.

--Trustees voted to approve Wells Fargo as the vendor to administer pension payments and tax reporting to pensioners for the RMC pension fund program. The annual cost is approximately $6,200.

The current pension service provider notified RMC that it could no longer provide pension administration services.

Contact the writer: [email protected] or 803-533-5551. Check out Zaleski on Twitter at @ZaleskiTD.

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