In the past three years, Chicago-based Cook County Health and Hospitals System lost at least $165 million in potential revenue due to widespread errors, including employee mistakes and billing lapses, according to an inspector general report cited by the Chicago Tribune.
In a 10-page report, the Office of the Independent Inspector General-Cook County attributed the revenue losses to staff errors during patient scheduling, registration and coding, as well as billing mistakes that resulted from a lack of accountability.
Some of the problems for the hospital system resulted from poor coding practices that led to wrong or incomplete coding, which results in insurance denials. In addition, the inability to properly schedule patient appointments was a "central operational inefficiency resulting in a significant number of claim denials," Cook County Inspector General Patrick Blanchard's report reads.
Further, the OIIG interviewed hospital staffers who said there are "a significant number of registration clerks, coders and billers who do not possess adequate self-motivation or the required skill sets and knowledge base" to do their jobs, according to The Tribune.
While hospital officials agree with the inspector general that the hospital system lost out on millions of dollars in revenue, they dispute the exact amount. Cook County hospital leaders estimate they lost between $79.5 million and $132.5 million, because what is typically charged is not necessarily what gets reimbursed.
The hospital system, which receives a portion of funding from the county, Illinois and the federal government, lost the money during a challenging financial period for both the hospital and Cook County.