Hillcrest writes off bad debt

McCOOK, Neb. -- Hillcrest Board of Trustees reluctantly approved writing off nearly a quarter of a million dollars in outstanding debt the facility is unable to collect.

A total of $227,000 from insurance companies and Medicare are due Hillcrest, but because of the lack of consistent follow-up the past few years, it was not collected, said Renee Wright, Hillcrest business manager, at the regular Board of Trustee meeting Monday morning. The billing snafu occurred before Wright was hired.

Part of the uncollected funds are the result of billing errors two years ago. In June 2012, Hillcrest Board of Trustees told Red Willow County Commissioners that three months worth of billing to Medicare and Medicaid were not done, following the termination of a billing clerk earlier in the year. One month later, at the request of Hillcrest Board of Trustees, Red Willow County Commissioners authorized a $1 million bank loan to Hillcrest to stave off potential cash flow problems. Hillcrest has since been making annual payments to pay back the loan, with payments of about $221,000 per year.

At Monday's meeting, Wright said in response to a question by board member Mike Eklund that Hillcrest cannot turn the bills over to collectors because per state law, insurance companies or Medicare cannot be sued for accounts over a year old. Some accounts date back two years, Wright noted.

Board member Randy Dean said the complicated billing structure for insurance companies and Medicare did not help the situation.

"We've known for a while that billing has been messed up, " Dean said, citing a recent auditor who recommended the write-off. Still, every business has some amount of bad debt to deal with, he added.

After voting unanimously to write off the $227,000, Eklund made it clear it wasn't what he really wanted to do.

"Ouch," groaned Eklund, shaking his head after the vote.

In an un-related issue, board members also voted unanimously to forward to Red Willow County Attorney Paul Wood unpaid bills of two residents, totaling around $250,000.

In other business:

* Colinda Nappa, Hillcrest administrator, updated the board on the status of finding another pharmacy, because of the recent closure of the North Platte pharmacy the facility was using. She reported that a business in North Platte and another local pharmacy are interested in providing medications for Hillcrest.

* Carol Grafel, a registered nurse who worked at Hillcrest for and a year and a half and recently left her position due to worsening rheumatoid arthritis, urged the board to take another look at a Hillcrest policy that she said denied her 62 hours of accrued vacation time that she says is due her. Grafel said if she is unable to get the vacation time, she would like the funds to be used toward the purchase of second lift for the 200 wing of the facility. Eklund encouraged Grafel to file a claim with the grievance committee at Hillcrest, with Red Willow County Commissioner Earl McNutt recommending that the policy be put on the agenda for next month, but the board took no action on her request as it was not on the agenda. [This paragraph was rewritten from an earlier version to a change a reference from "overtime" to "vacation time." Administrator Colinda Nappa said the issue involved "accrued but not available vacation time."]

* one LPN and four CNA's have been hired, Nappa reported, with another offer extended to a registered nurse who will start in December. There are 94 residents at Hillcrest as of Monday, compared to 87 last year, with five in skilled nursing, one each in hospice and Medicare, six with the Veteran Administration, 44 private pay and 37 state. There were six admitted and seven discharged last month.

* Board member Karen Klimnet Thompson asked that information be presented each month at the board meetings, concerning board members' responsibilities. She cited as an example code of conduct and conflict of interest policies, that should be reviewed annually. Nappa responded that she would present information for board each month concerning this.

* Randy Dean showed the board a brochure from a design firm in Kearney, Nebraska, concerning the construction of a proposed chapel at Hillcrest. Dean said there have been no bids yet but that Pam Harsh of the Hillcrest Foundation needs some sort of design before she can start fundraising. Funds for the chapel would come from the foundation and not from Hillcrest, Dean clarified.

* The American Healthcare Association has awarded Hillcrest a Quality Initiative Recognition award for reducing hospital re-admissions. Nappa said she will be going to Texas to accept the award.