County Approves $150,000 for Medicare/Medicaid Billing Consultant for Health Department, Nursing Home

Will County will hire a consultant to review Medicare and Medicaid billing practices at both the county health department and Sunny Hill Nursing Home, aiming to maximize reimbursements and address increasing regulatory compliance challenges.

The Finance Committee approved allocating $150,000 from contingency funds on Thursday to secure consulting services to examine and potentially improve billing practices at both county healthcare facilities.

“We’re requesting to use contingency funds to issue an RFP to hire a consultant to help them look at best practices for Medicaid and Medicare reimbursements, to make sure that they’re maximizing and getting the max that they can receive in reimbursements on revenue,” explained a county financial official.

Health Department officials noted that more than 50% of their clients are Medicaid recipients, with additional Medicare and dual-eligible patients, generating approximately $7 million annually in Medicaid revenue and $170,000 in Medicare funds.

“If we’re missing something because of changes or the complicated billing, then we would like to enhance it and capture even additional revenue,” said Denise Bergen from the Will County Health Department. “Any enhancement to our revenue, any advice on changes we can make to improve our reimbursement, we are much appreciative.”

Sunny Hill Nursing Home administrators described increasing scrutiny from federal auditors looking to recoup payments from previous years, commonly known as “rack audits” conducted by the Office of the Inspector General.

“What’s happening currently is OIG is undertaking a lot of rack audits, and they’re looking at months, years after a resident has actually been a resident at the facility,” explained Maggie McDall, Sunny Hill administrator. “They’re looking to recoup money.”

McDall noted that some audit claims have been for approximately $10,000, but others have been for larger amounts. The facility is also experiencing delays in Medicaid approvals for new residents.

“When we apply for public aid for most of our residents, which is a very complex process… we get assigned different case workers. You never have the same person. The process is delayed months and months,” said Shelley Felicx, Director of Finance for Sunny Hill.

County Board Leader Jim Richmond supported the initiative, noting that Sunny Hill is currently losing approximately $3.5 million annually, which equates to about $57 per bed per night.

“We’ve got to turn some of these ships around,” Richmond said. “Hopefully if we spend this $150,000 or less than $150,000, we can find out areas where hey, we weren’t billing the right amount, we can now bill more.”

The $150,000 allocation is intended as a one-time expense rather than an annual cost. Officials emphasized that the consulting services could help protect against future audits while potentially increasing revenue.

The committee approved the request with the understanding that the funds will be drawn upon as needed until the allocated amount is exhausted.