The Eureka Springs Hospital has been failing to collect “professional fees” for a number of months, resulting in a loss of approximately $800,000.

That was the biggest financial revelation that CEO Tiffany Means shared with members of the hospital commission during the commission’s monthly meeting on Monday, Feb. 23.

“… Talking about codes and including professional fees,” Means said. “The most common thing that we have missed that has been recognized in this statement here has been the professional fees.

“So, sadly, this recognition came when a patient called me to pay their bill, and I was looking at their bill. … I was looking and it was missing professional fees, so it had me dive in deeper into those professional fees.”

Professional fees are collected from patients to help pay for contracted services in order to execute hospital operations, the commission was told.

“… When they were being credentialed, they were not being credentialed correctly ….,” Means said. “With that, for a year with the new group, we have been denied and not been charging professional fees.

“… Our estimate has been an $800,000 loss.”

Commissioners asked if that amount could be collected retroactively.

“You can go back a certain amount of days, but after that you’re done and cannot do it,” Means responded.

The hospital’s previous contract provider took care of the professional fees, but that’s not the case with the current provider, 360 Degree Medicine, commissioners were told.

“The way the new contract with the new providers … is, the hospital was going to be responsible for the professional fee billing,” Means said, adding that the failure to collect the fees was discovered “about four weeks ago.”

Getting all providers the necessary credentials has also become a priority after it was discovered recently that proper credentialing had not been done, Means continued.

“It’s is a lot of work right now to get approximately 30-some providers that are credentialed at our hospital individually signed … and then all insurances notified individually for each provider,” she said.

“So, if we have Patient A come in tomorrow, and they’re seen by one of our providers, and they’re not credentialed with that insurance company that the patient is covered by, are we hung out to dry right now?” commissioner Brian Beyler asked.

Means responded: “Yes, we are. We’re working on it, but it’s CMS (Centers for Medicare and Medicaid Services) that we’re first working on, and then we went to the providers that work here the most to go through that process first.

“So, you look at it this way: We’ve been paying our providers through contract, expecting to be reimbursed with the professional fees, and we have gotten zero. So, you pay $1.1 million to a contract, which they will be here a year now, and we didn’t charge professional fees on that.

“That’s just one discovery we will share today, OK?”

That “discovery” was another in a list of financial hiccups discovered since former hospital chief financial officer Cynthia Asbury was terminated on Dec. 29. It was later revealed that the hospital owed more than $200,000 to the company that provides medical records software to the facility.

‘SYSTEM FAILURES’

Means’ report began with a positive twist, continuing to outline the hospital’s ongoing reorganization and behind- the-scenes cleanup, from financials to records to building improvements.

“Everything we’re doing is grounded in our commitment to serve you, provide safe and reliable care, and ensure that Eureka Springs Hospital operates in a financial, sustainable and professional accountable manner,” she said.

Multiple issues have been discovered, though, Means said.

“As we continued our deep review of operations, the interim CFO and I have uncovered issues that are both significant and long-standing,” she said. “These discoveries have been extraordinary in scope and help clarify why concerns have existed for many years.

“What we are seeing today reflects system failures that developed over time, processes that were not aligned with best practice, guidance that was not sought when needed, and operation decisions that did not set the hospital up for long-term success. This is not personal, but it’s transparent. What matters now is that we fully recognize these issues. We are not applying temporary Band-Aids, and we are not ignoring root causes. We are here to rebuild ESH into an operationally sound, professionally run, and financially responsible organization, one that this community can trust and one that fully, truly reflects the mission and vision we are putting forward.

“As we at Eureka Springs continue to move through a deliberate financial and operation reset, this transition we are addressing, it does identify some system and long gaps that creates such a fragment that has gotten us here today. We’re just trying to get it all back organized in the way an operation of a hospital should be. So, as we move forward with these discoveries and continue to work on rebuilding, it’s important that we anchor and clarify our direction and shared purpose. A hospital cannot regain stability or trust without a unifying foundation, one that guides decision- making, culture, service expansion and financial stewardship. With that in mind, we are bringing forward an updated mission and vision for Eureka Springs Hospital. These statements are not simply words on paper. They represent the standard we are committing to uphold in the future we are intentionally building for this community.”

REGISTRATION ISSUES Process issues began at patient registration, Means said.

“What must happen at the patient registration — this is the first stopping point — is to capture accurate demographics, verify insurance, and obtain pre-authorizations,” she said. “They are the very first part of the revenue cycle as we go through this process. So what’s commonly happened is incorrect or missing insurance data that has led to denials, rework and delays in billing and payment. So, we’ve had some patients call and say: ‘You know, my insurance wasn’t accurate.’ We’ve had coders call us to say their primary wasn’t listed first, which we need to go through their primary.

“So, we’ve done extensive coaching and education and restructure of that registration piece with the team so that they can understand. They are the first part of this revenue cycle process. If they don’t get it right there, it just kind of stops until it’s fixed. And then if it’s not fixed, then it leads to inaccuracies in the billing issue with the patient and the insurance claim.”

OTHER ITEMS

Means shared with the commission that outpatient infusion services are now up and running, and the hospital will host another community engagement event, with cookies and tea, from 3 p.m. to 5 p.m. Thursday, March 19 at the hospital.