The financially challenged Commonwealth Healthcare Corp. could boost its revenue if it aggressively pushes for the collection of unpaid reimbursements owed the hospital, according to an analysis conducted by HealthTech.
In a 13-page summary of recommendations submitted to Gov. Benigno R. Fitial, the HealthTech analysis affirmed that the CNMI's healthcare system poses an immediate threat to people due to multiple deficiencies and shortcomings. It submitted several recommendations that need action plans within 30 days.
Among these “immediate recommendations” is in the area of revenue cycle, where it disclosed $11.4 million in unpaid reimbursements to CHC could immediately increase the hospital's income.
“To increase reimbursement within 30 days, focus on unpaid Medicare claims [amounting to $8,398,551]. Assign a couple of best Medicare billers to work the return-to-provider area in the Medicare online system. Contact the Medicare Intermediary to obtain assistance with resolution of unpaid claims,” states part of the analysis.
The corporation should also focus on unpaid Aetna claims amounting to $2,970,947.70 million and recommended assigning a couple of Aetna billers to resolve errors that are preventing the claims from being paid. Aetna is an insurance carrier.
In combining these two unpaid claims for CHC, the hospital can potentially collect $11.369 million within 30 days.
The analysis also recommended getting more personnel from other positions to help in the hospital's billing area so that billing productivity is not compromised.
It also suggested evaluating current roles and responsibilities of employees and reorganizing the staff to put workers in positions that are currently vacant and in backlog areas that need help.
“Reallocate additional resources into the payment posting area so backlog can be resolved. Ensure that the most current dates of service are coded and billed timely. Divide the coders and billers so that one group works on the most current claims and the other group works on 2011 claims,” the study recommends.
Besides the unpaid reimbursements from Medicare and Aetna, the corporation also has huge collectibles from patients whose billings were delayed for many years.
The Office of the Governor commissioned the study on the public hospital using federal grants.
'Eliminate posts; reduce OT'
HealthTech also proposes to eliminate or consolidate many positions. Among the position suggested for elimination is that of director of hospital services.
The study proposes to combine nurse manager positions in many departments and eliminate the position of chief of general support and transfer the responsibilities to the facility maintenance administrator.
In eliminating those positions, the savings can be used to fill or add important positions, mostly on the clinical sides.
It also recommends at least 5 percent reduction in overtime costs of personnel.