UPDATE, 4:40 p.m. June 30 by Diane Heldt
IOWA CITY — Staff error, vacant positions and a lack of automated billing for a specific procedure helped cause a University of Iowa Hospitals and Clinics error that led to $11 million in delayed patient charges, an analysis revealed.
UI officials released on Wednesday the results of a hospital analysis conducted after the missed billings were discovered several months ago. Officials told the state Board of Regents in April about the problem. All of the patients were eventually billed, so it will result in no lost revenue, officials said.
“Certainly (lack of) automation played into it, and failure of our staff to do what needed to happen,” Chief Financial Officer Ken Fisher said.
The hospital did not fire anyone as a result of the mistake, but one employee left for another job, Fisher said.
Automated billing is used for 77 percent of patient charges, Fisher said. That means if a patient has a chest X-ray, the fact that an X-ray happens results in a bill.
In this case, all of the missed billings were in the Heart and Vascular Center, for patients undergoing cardiac catheterization lab procedures. For that procedure, a staff member must manually review the documentation and procedure log for each patient to determine what charges are appropriate. There was no automated monitoring system to identify potential missed charges, the analysis said.
Also, “cath lab” support staff during that time was only one person, with two other support jobs vacant due to budget cuts and turnover, Fisher said. The hospital has five cath labs and does an average of 22 procedures a day, he said.
Those combined factors led to the billing mistakes, the analysis concluded.
The hospital will continue to automate billing for more procedures when possible, Fisher said.
“That’s our desire … as opposed to having a human intervention in the process, which is not nearly as desirable,” he said.
Another goal is to add at least one more support employee to the cath lab area, he said.
Hospital officials also will create educational programs for department managers on ways to monitor billing activities, and develop a charge dashboard that allows reviewers to compare daily charges to historical data, according to the analysis.
“With continuous monitoring now in place, this problem is very unlikely to occur again,” the report states.
An internal audit discovered that the missed billings began in November. They were corrected in March, officials said. The hospital bills about $235 million monthly in gross charges.
————————————————————————–
IOWA CITY — A University of Iowa Hospitals and Clinics error that led to $11 million in missed patient billings was due to vacant staff positions and a lack of software automation, according to an analysis of the problem.
UI officials today released the results of a root cause analysis, conducted by hospital leaders after the missed billing were discovered. Hospital officials told the state Board of Regents in April about the problem. All of the money ultimately will be paid, so it will result in no lost revenue, officials have said.
The analysis determined several factors led to missed charges in the hospital’s Heart and Vascular Center. The factors include a lack of automatically generated charges in the software program used by the Heart and Vascular Center. For cardiac catheterization lab procedures, a staff member had to manually review the physician documentation and procedure log for each patient to determine what charges were appropriate. There was no automated monitoring system to identify potential missed charges, and during the time period reviewed, support staff for those procedures was one person, as two of the three positions were vacant.
The center will fill those vacant positions on the support staff, and will create ongoing educational programs for department managers to discuss ways to monitor billing activities. The hospital also will develop a charge “dashboard” that allows reviewers to compare daily charges to historical data. Officials also will continue to pursue automation of such activities.
“With continuous monitoring now in place, this problem is very unlikely to occur again,” the report states.
The internal audit discovered that the missed billings began in November. They were corrected in March, officials said. UI Hospitals and Clinics bills about $235 million monthly in gross charges for physician and hospital services.
