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Glens Falls Hospital

The C.R. Wood Cancer Center is seen Thursday at Glens Falls Hospital. The Post-Star talked to several workers in the billing department of the hospital, who described the changeover to a new billing system that contributed to the hospital losing $38 million in revenue.

GLENS FALLS — Billing problems at Glens Falls Hospital persisted for more than 20 months after the hospital switched to a new system, workers said.

In 2017, the changeover to the system lost the hospital $38 million, according to an independent auditor’s report. No audit has been done yet of the 2018 books, so it is not clear how much of the $18 million deficit for 2018 was due to billing problems.

But doctors and workers described a system that went “live” long before it could handle all of the billing needed for the many entities run by the hospital, which range from the C.R. Wood Cancer Center to primary care sites.

In 2016, Glens Falls Hospital outsourced its Information Technology department to Cerner, from whom the hospital was buying a new billing program. Cerner hired some of the hospital’s IT staff and began customizing the billing system code to fit the hospital’s needs. A Cerner spokeswoman confirmed that but did not answer further questions.

The system went live in November 2016.

Troubles arose quickly, and in early 2017, the hospital called in Grant Thornton to take over billing while Cerner’s IT department worked to debug the system. Grant Thornton, an accounting and financial advising firm, confirmed its ongoing work with the hospital but declined to discuss it further, citing a policy against discussing clients.

Time was of the essence when Grant Thornton supervisors arrived. Every insurance company had given the hospital an extension on the normal deadline for submitting claims, but in January, the hospital was three months into the new system and still unable to send out many bills. Commercial insurance often denies claims after three months.

But insurance companies understood that billing problems often come up after a change to a new system. CDPHP, for example, kept accepting old claims through June 2018, a 20-month extension. Others accepted late bills as well, although for a much shorter period of time — four to six months.

The problem was that, even in June 2018, the hospital still had many late bills. At that point, the new billing system had been in place for 20 months.

It was only then, in June 2018, that the system was successfully configured to bill for outpatient behavioral health, said Mick Powers, who used to work in the hospital’s billing department. Those bills were fairly small, often $97 for a therapy appointment, of which insurance paid about 85 percent.

“These might seem like small potatoes,” he said. “But when you consider thousands of people having therapy two or three times a week, for a year and a half, it adds up to a heck of a lot of money.”

That’s $247 a week, per patient, for 20 months.

Patients reported not getting billed for months on a variety of care, with one patient saying he had not been billed for at-home dialysis from November of 2016 through now. His costs are usually $20,000 a month. He just got a $14,000 bill dated from 2016, he said.

The family of another patient said they just got a bill for a hospital stay from last July. The insurance paid on Aug. 28, but the patient owed $900, said daughter-in-law Jane Weller. Last week, the family finally got the bill — more than seven months after the hospital stay.

One of the problems with the new system involved the way in which it auto-filled the name of the doctor on each bill.

Workers said the system would inexplicably put the wrong doctor on a bill — listing, for example, an orthopedic doctor for an emergency hysterectomy — and then insurance would reject it.

“A lot of times, the system wouldn’t even list the doctor,” Powers said. “You had to research the doctor and the doctor’s tax ID and the license number.”

Given the number of doctors working in a primary care center or a busy operating room, it could take a great deal of time to figure out which doctor did what on a claim that was already months old.

Additionally, workers said the billing department is short-staffed.

Even before the changeover to Cerner, Powers said, staffing was a problem. A worker who handled all bills of less than $200 was not replaced when she left. Workers in the department, which handles any bill that needs to be fixed due to a missing or wrong element, prioritize bills by dollar amount and sometimes don’t get to the small ones.

Powers once worked an overtime shift just to write off many $17 claims.

“That’s all I did in overtime, was writing those off because they were too untimely,” he said. “That was before Cerner. That was a lack of staffing.”

After the changeover, it got worse. Workers found themselves having to fix so many bills that they could not keep up. At one point, Grant Thornton announced a quota of 100 bills a day, per person — and some workers, including Powers, couldn’t do it, because each bill had so many problems.

Powers worked on CDPHP claims.

“We had a policy in place (with CDPHP) for Glens Falls Hospital. They would process them manually after they were denied as untimely,” he said. “But they wouldn’t let me call with 100 of them and keep someone on the phone for half an hour. So I had to call with every five claims and say, ‘These were denied as untimely, could you please send them to processing to process them by hand?’ CDPHP was very lenient.”

When even CDPHP stopped accepting late claims in June of last year, Powers told a Grant Thornton supervisor it was time to tell hospital executives to give up.

“Just abandon the ship,” he said. “He told me it cost $10 million, so abandoning it would not be considered.”

Hospital administrators and members of the board of governors did not return repeated calls and emails seeking comment.

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You can reach Kathleen Moore at 742-3247 or kmoore@poststar.com. Follow her on Twitter @ByKathleenMoore or at her blog on www.poststar.com.

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reporter - Health care, Moreau, Queensbury, South Glens Falls

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