The lack of an automated monitoring system and inadequate number of staff members led to $11 million in billing charges missing from the University of Iowa Hospitals and Clinics cardiology department.
UIHC officials told the state Board of Regents at its April meeting about the missing funds after discovering the error through an internal audit. Since then, hospital leaders have worked to find the root cause of the problem, with the final analysis released Tuesday.
The audit was the first since the implementation of the EPIC program, which provides staff with access to electronic medical records. However, the $55 million system was not exactly responsible for the billing errors.
The analysis showed the problem occurred in the UI Heart and Vascular Center starting in November 2009, when there was a lack of electronic interface between the EPIC and billing systems, said Ken Fisher, the UIHC’s chief financial officer. A staff member needed to manually review the physician documentation and procedure log for each patient to determine what charges were appropriate. Instead, patients and insurance companies did not receive payment information promptly.
People were eventually charged correctly, and the hospital has recovered the $11 million with no lost revenue or effect on patient care, Fisher said.
“We were upfront about the issue,” he said. “Nobody was hurt, and we have billed and collected all charges.”
During the time when the billing errors occurred, two positions in the Cardiac Catheterization Lab remained vacant, causing the support staff to consist of only one person, according to the report.
“The whole purpose of the analysis is to find reasons and to make the right correction to the system so it does not happen again,” said Jean Robillard, the UI vice president for Medical Affairs.
Officials periodically request an audit to discover potential issues, and the audit that discovered the billing errors was one such audit, Robillard said.
Despite hospital employee and officials best efforts, errors can occur, said Regent Robert Downer.
“When a large enterprise is dealing with a huge number of bills and individual entries, there are going to be errors at some point,” he said.
Downer, who in April said he believed the billing problems could be the result of human error, noted the problem has been taken seriously by UIHC officials.
“Errors need to be identified and corrected as rapidly as possible, which was the approach taken in this instance,” he said.
The report stated the UIHC will fill vacant positions in the Heart and Vascular Center and create a program to educate staff members on importance of charging insurance companies and patients promptly to avoid any future problems.
Downer expects UIHC officials to discuss the recovery of the $11 million at the August regents’ meeting.
“I have every confidence this will be presented as part of the internal audit report or the hospital committee report to be sure the full board knows how seriously this has been taken,” he said.