LUSK - The Niobrara County Hospital District Board met on Tuesday, March 26 at 5:30 p.m. in the Board room of Niobrara Community Hospital. They passed their agenda with no changes. During public comments, trustee JV Boldon stated that during his walk around town the primary feedback he received was that individuals are anxiously awaiting the arrival of the small ultrasound machine in the clinic that will work for blood clot ultrasounds. This machine is on its way. Approval of the minutes was given pending two minor corrections

Financial Reports were presented. February patient revenue had decreased from January and December as the number of swing bed days and inpatient days in the hospital were down from previous months. Total revenue was down 60% from January, again, largely due to the decrease in patient days and a decrease in ER visits. This results in lower revenue in all supporting ancillary departments. Tax revenue for the month was $171,000. Total expenses have remained constant from month to month. The month of February showed a net income of $119,000 and is sitting at $551,000 for the fiscal year. Salaries and benefits have gone up as the organization transitions from the self-insured plan to Blue Cross Blue Shield as they finish paying any outstanding claims on the previous plan. These expenses should be gone by the end of the fiscal year. Operating account balances did not reflect the influx of cash flow from the County of $500,000. The terms of the money have not yet been presented to the district and it is unknown if there will be payback terms or it will simply come out of the funds that have been held for the district. Cost report money has been received and payables are current.

Extensive discussion was held regarding the accounts receivable aging report. Right now many of the aging claims from Medicaid and Medicare are those that needed corrected and refiled. The finance and billing departments have been working diligently to clean up all aging claims that needed resubmitted to both Medicare/Medicaid and private insurance. Many of these claims were the result of the Athena system transition that resulted in claims with errors or missing components. Additionally, there has been a delay in claims submission from the first part of the fiscal year that was the result of physician signatures not being timely on documentation. The new management has been working diligently to set a new standard of documentation completion to improve this error rate. It is also important to note that the Aging AR report is based on discharge date as opposed to billing date, which is going to make all accounts look older than they actually are depending on this timeline. Discussion was held regarding changing the format of some of the financial reports to more accurately reflect those accommodations.

All self-pay accounts have been switched over to a new collection company. This is a company that has been successful in Sundance. They charge 25% of collected totals. It was asked what the average number of days were from day of visit to billing date. The finance department will calculate this and get back to the board. Statements are sent out every 35 days. All accounts over 90 days will be treated as though it is day one of the billing cycle and they will restart the billing clock on all self-pay accounts since there is no way of knowing how accurately the previous collections company was working those accounts. The new company will be starting by April 1. The financials for May should begin reflecting the new company’s work.

The board discussed ongoing issues with the Athena system. It was determined by administration and the board that a re-evaluation of the system would be warranted however given the costly nature of transitioning to a different system at this time it will likely be recommended to stay with Athena until a better solution can be presented.

Clarification was sought regarding the HMS management fee. The fee does not reflect income prior to write-offs, only contractual adjustments. Write-offs are all bad debt. These categories should be combined. The management fee is gross revenue less contractual adjustments.

The board also requested comparative income statements and balance sheets that show the entire fiscal year month-to-month. Since Athena is unable to generate this report the finance department will create them.

A new policy was presented to the board that is required regarding protected health information. Patient days are short of budget and clinic visits are down slightly. There were 28 hospital admissions in February.

The roof project is moving forward. There was a contractor mistake regarding the asbestos testing for the roof and so the contractor will have to start the process with state again however this will not be on the hospital nor will the hospital have to pay for the delay. The portion of the roof that is being replaced is the south end that leaks. The maximum warranty the contractor was able to find for roofing was a seven year warranty. The shower room is still in a holding pattern and the hospital is seeking bids on the HVAC system. This will be put on hold until the next fiscal year so that it can be included in the budget process. The HVAC system needs to be done at the same time as the roof project and the board instructed administration to go ahead and complete the heating system at this time as the funds are available for that.

The 340B drug program is up and running. The agreement has been signed and the hospital has received the first invoice and verification. The district should begin to see cash flow from the 340B program by March or April.

The finance department is still trying to finalize the audit. They estimate that it will be done before the end of April. May’s meeting should have an audit report.

The Board moved into executive session and then adjourned.