Eureka Springs Hospital leaders outline deep revenue-cycle failures, $800,000 in missed professional fees

Eureka Springs Hospital’s CEO Tiffany told the Hospital Commission on Feb. 23 that a multiweek review with the interim chief financial officer uncovered widespread, longstanding problems across the hospital’s revenue cycle, from front‑end registration to claims submission and denial management.

Tiffany said the review revealed “system failures that developed over time,” and that the leadership team is pursuing structural fixes rather than “temporary band‑aids.” She told commissioners that incorrect or missing insurance information at registration, incomplete clinical documentation, and lapses in credentialing contributed to delays and lost revenue.

The most concrete finding the CEO reported was that professional fees were not billed after a provider‑contract transition, costing the hospital an estimated $800,000 in missed professional‑fee revenue. Tiffany said the shortfall resulted when providers who moved under a new contract were not correctly credentialed and an 855R enrollment process was not completed for each insurer, preventing the hospital from billing professional fees tied to those clinicians.

Velvet Schultz, a hospital staff member who assists with chart review and coding, explained why clinical-detail queries matter: “Short of breath isn’t a billable diagnosis,” she told the commission, describing how coders submit nonleading ‘can queries’ to clinicians to clarify diagnoses so that coding reflects acuity and regulatory standards.

Tiffany said a contracted billing specialist has helped reduce a claims backlog in the hospital’s scrubber from about $3.3 million in full charges on Jan. 1 to under $1 million in five weeks; she emphasized those full charges are not guaranteed reimbursements and require further coding, appeals and insurer follow‑up.

The CEO also flagged insurer denials tied to an NPI number change after the hospital’s transition to a critical‑access designation. Tiffany said she has escalated the issue with Ambetter and continues to track ticketed denials but described vendor and insurer responses as “slow moving.” She said the hospital also has filed a grievance with its billing‑platform vendor, Oracle, after patients reported confusing statements and trouble reaching a live representative.

Commissioners asked about checks and balances. Tiffany described a daily census and a two‑check process involving clinical operations lead Pam, contract coders and internal staff (including a staff member identified as Doug) to identify missing documentation and route corrections for coding. Jody Edmonson, the hospital’s HR director, was cited as managing credentialing outreach for providers, which Tiffany said is a labor‑intensive effort to enroll roughly 30 providers with insurers.

Tiffany said the hospital expects to present finalized December and January financial statements in March after the interim CFO returns from planned leave. She framed the effort as a deliberate “financial and operational reset” that will require staffing or role changes only after cleanup is complete.

The commission did not take formal policy action on the revenue recommendations at the Feb. 23 meeting; the board set a follow‑up schedule and directed staff to continue cleanup and vendor escalation.

The commission’s next regular meeting is scheduled for March 16 at 1:00 p.m.