06 Feb 2018
- By Cherrie Anne E. Villahermosa – [email protected] – Variety News Staff
A REPORT from the Office of the Public Auditor found that the Commonwealth Healthcare Corporation failed to manage patients’ accounts receivable and has 11 unresolved recommendations.
In its status report issued as of December 31, 2017, OPA states that it has tracked 24 audit recommendations made to five NMI agencies; namely, the Commonwealth Utilities Corporation, CHCC, the Department of Lands and Natural Resources, the Department of Public Safety and the Department of Finance, Division of Customs.
The report states that a total of 20 unresolved audit recommendations for these five agencies were tracked and CHCC had the greatest number of unresolved recommendations.
In its findings, OPA said that CHCC, aside from its failure to manage accounts receivable, it is not in noncompliance with procurement regulations in CHCC’s use of an independent billing and collection firm and is inadequate in terms of reconciliation of forwarded accounts.
In its report, OPA recommended that CHCC develop and implement policies and procedures to promptly verify patient’s insurance coverage and eligibility, discuss payment requirements and options with patients at the time of registration; collect upfront payments from all patients regardless of coverage, unless it is certain that the insurance or guarantor will pay the bill in full. If patients are unable to make payment, CHCC should discuss payment options with them and ensure that follow-up procedures are performed. Require that doctors and nurses prepare the information necessary to estimate a bill at the time a patient is discharged; develop a plan of action that is effective and timely and addresses the current backlog related to coding, billing, collection and posting payments.
None of these four recommendations, so far, has been resolved.
OPA’s report states that in response to the first recommendation, which is to develop and implement policies and procedures, the Corporation responded that they have access to verify eligibility for Medicare, Aetna and all Guam-based insurance carriers. Payment is being requested, payment reminders and payment options are all discussed at the time of registration or checkout.
OPA reviewed and confirmed that the draft policy contains procedures that provide staff with the necessary guidance for performing prompt verification of patient insurance coverage and eligibility and addressing payments requirements.
However, OPA said they consider this recommendation to be unresolved until the policy is approved and implemented.
CHCC in their response to the second recommendation, which is to collect upfront payments from all patients regardless of coverage, stated that upfront payments are being taken at the time of registration or checkout depending on the patient’s medical condition.
CHCC stated that payment options including payment plans were being discussed when patients are unable to make a payment.
OPA stated that CHCC provided the requested documents for OPA to determine the extent of implementation, but OPA considers this recommendation unresolved until they can make a proper determination in the June 2018 ARTS report.
On the recommendation that doctors and nurses prepare the information necessary to estimate a bill at the time a patient is discharged, CHCC responded that estimates are provided to the patients upon discharge based on the level of care received and documented by the provider.
OPA stated that despite this policy being approved in March 2016, it noted indications of non-compliance during the audit.
For the recommendation that CCHC develop a plan of action that is effective and timely in addressing the current backlog related to coding, billing and collection, CHCC responded that the backlog has been minimized significantly.
CHCC stated that, at the time of the review, CHCC had no Director of Revenue Cycle to lead the Business Office and provide guidance.
CHCC said previous the backlog went back over 12 months, but now it has been reduced to 5 to 6 months.
The other recommendations of OPA for CHCC that are still unresolved include the following:
CHCC must seek technical assistance that would result in the assessment of the current IT structure and the acquisition of a comprehensive accounting and billing system; develop and implement policies and procedures effectively to address claim denials and rejections; provide staff with relevant documentation and training and develop and implement policies and procedures effectively to review third party reimbursements; adopt and publish a listing of all procedures and related fees in one complete schedule; update contracts with insurance companies; reconcile all billings created and payments received from the contractor; any discrepancy should be resolved and the overall effect should be analyzed and documented; and lastly comply with CHCC’s procurement regulations when seeking the services of an outside billing and collection agency.
Source: Marianas Variety : http://www.mvariety.com/cnmi/cnmi-news/local/102039-opa-chcc-fails-to-manage-billing-has-11-unresolved-recommendations