Cook County Hospital Board Outlines Revenue Recovery Strategies

Cook County Health and Hospitals System (CCHHS) Board Meeting - May 25, 2018

What did the Board decide:

The CCHHS Board committed to add coders & billing staff, increase training and clinical documentation, and enforce performance standards for all employees who affect the revenue cycle process in order to improve revenue recovery.

• Board chairman Hill Hammock and CEO Dr. Jay Shannon will present these revenue recovery strategies to the Cook County Board at a hearing at 1 p.m. on June 5.
• CFO Ekerete Akpan explained the role of 3rd party billing, claim “denial prevention,” careful documentation, high-return medical procedures, and high quality EMR software, which the hospitals system hopes to acquire, in recouping revenue. After documenting and coding a patient encounter, a claim is prepared, submitted to the payer, and sometimes resubmitted.  Additional 3rd party billers will engage with insurance companies regarding denied claims. Ongoing training will improve the skills of staff managers who use scheduling, registration and verifications systems.  Coding is complex!  There are “cheat sheets” with codes that insurers will pay.  Revenue comes from procedures with the highest return, e.g., surgery and joint replacements.  All employees who affect the revenue cycle process are trained in the use of electronic medical records (EMR), where prompts tell you the level of coding.  Akpan said he hopes the hospitals system will acquire 3M software to provide more detailed information on the patient’s condition.
• Net Accounts Receivable (AR) outstanding as of 3/18: $91.1m - “what we think we can collect”; 120 average days in AR; Discharged, not finally billed: $31.5m; Initial denials $10.9m.

Dr. Shannon, CCHHS CEO, spoke at some length about the issue of revenue recovery, explaining, “We recognized this as a challenge years ago, and embedded strategies in the strategic plan to meet the challenge.”  Until 2014 billing was simplistic, but now the system has 20 payer contracts.  Despite the challenges, patients and local taxpayers have benefited: taxpayer liability has been reduced by 75% since 2009, and the system has been able to redirect $2.5b to other Cook County needs over the last ten years.  The system dispensed $300m in charity care in 2017 without additional resources from local taxpayers.

Other Data Presented to the Board:

• 331,000 CountyCare members as of May 1, of whom 60,000 have a primary care provider with the County HHS.  48% of visits to neighborhood clinics (ACHNs) in 2017 were CountyCare members.  CountyCare represents 11% of total Hospital System revenue.
• Over 180,000 patients were lost from Medicaid rolls early in 2018 due to the state backlog of patients who must recommit each year; some lost benefits in the interim.  A concern is that some patients may not go back into the system.
• Overall system operating expenses were 21% above budget as of May 1, attributed in part to sole product providers (no possibility of a  competitive bid). Surgeries increased 5%.
• 42% of Cook County Health and Hospital System patients are uninsured, vs. 38% last year.

The Health and Hospitals system will allocate about $1m this year, and $2m next year, to staff a continuum of behavioral health services to be provided to detainees at the Cook County Juvenile Temporary Detention Center (population 200-250), similar to the services provided at the Cermak Clinic.

To Watch For: 
Will there be a state budget by May 31?  If not, the hospitals system is at risk for cash flow problems!

Observers - Linda Christianson and Marcia Powers                   Meeting Length - 3 hours