Hospital board hears revenue-cycle assessment, reviews July finances

An outside revenue-cycle firm and hospital finance leaders briefed the board on account-collection problems and July financial results, with staff outlining next steps including targeted collections and corrected Medicaid cost-report filings.

Patricia Chua, chief operating officer of Anova Revenue Group, told the board the firm’s review of the hospital’s Epic billing data showed three primary problems: a large share of outstanding balances classified as self-pay, provider-enrollment errors that trigger denials, and late professional claims that are harder to collect. "So we are an end to end revenue cycle company... Pulled the report out of Epic, and we noticed that, you know, we noticed 3 main areas where you guys need improvement," Chua said. She added that "30 to 40% of your outstanding balances are patients in our pocket."

Why it matters: staff said fixing billing setup, provider enrollments and timeliness could increase collections and reduce high accounts-receivable (AR) days. Finance staff reported gross AR days of 52.6, noting the board’s target is about 45 days. Hospital leaders said a large portion of older balances are self-pay accounts and will require active outreach or collection actions.

Details of the July finances: presenters reported total patient revenue of about $2.6 million for July versus a budgeted $2.5 million. After contractual adjustments and other operating items, net patient revenue was reported at roughly $2.29 million. Salaries were about $1.2 million (below a $1.4 million budgeted figure), while total operating expenses were reported higher than budget. The hospital reported a net loss of about $171,000 for the month. Finance staff identified $926,000 in accounts over 61 days, most of it self-pay.

Staff actions and next steps: finance staff said they will (1) pursue collections and qualification for financial assistance for eligible patients, (2) continue talks with outside revenue-cycle vendors to centralize workflows and correct provider enrollment/billing setup, and (3) complete corrected Medicaid cost reports and request rate reviews. A finance presenter said the hospital will aim to complete the 2025 Medicaid cost report by November and use the same audit/cost-report team to accelerate filings. Staff also reported they had two patient-account cases they were referring to Allison (collection/legal) for further action.

Other operational and revenue notes discussed in the meeting included retail pharmacy revenue of about $430,800 (below a budgeted $546,000), supply costs that exceeded budget ($740,000 vs. $593,000 budgeted), and several small grants and one-time receipts reported for the month (items cited included dementia-training funds, an IT cybersecurity grant, an NVquip training amount and mill levy receipts). Presenters also said they had asked a collection agency in Gillette about pre-collect programs to help set payment plans and identify patients eligible for sliding-fee financial assistance.

Board and committee context: the finance committee reviewed department-level data in detail and asked for at least one or two more months of department reports before producing condensed reports for the full board. Presenters said they now have month-level departmental numbers that will allow the board to make better financial decisions as more months of consistent data are reviewed.

Ending note: the hospital will continue work with the outside revenue-cycle firm to correct billing classifications and provider enrollments, pursue selected collections, and file corrected Medicaid cost reports to seek rate adjustments. Finance staff asked for additional time to refine department-level reports and return with more consolidated figures to the board.