Accountability move — WCHS accelerates financial work as state withholds funds
At the recommendation of a new executive, the Weston County Health Services board of trustees voted Nov. 20 to hire a company to help the hospital meet an upcoming audit deadline.
Chief Financial Officer Paul Maiellano proposed bringing on Elevate CPA to help clean up the general ledger and determine whether there are any “irregularities” that would need to be reported, according to CEO Cathy Harshbarger.
Maiellano said the hospital doesn’t currently have anyone besides him who is capable of performing general ledger work and that he is concerned the hospital will not meet the deadline for submitting its audit without outside assistance. Elevate CPA would work at a rate of $100 per hour.
Harshbarger said she could not estimate how many hours it will take Elevate CPA to review the records. She asked the board for budgetary flexibility because the work is essential for the hospital’s state-required audit.
Maiellano told the News Letter Journal he had worked with Elevate CPA before joining WCHS, having hired the firm to evaluate a health care facility in a mergers and acquisitions context.
At the meeting, he said he is confident the firm will complete the work correctly and on time.
“We’re at the point where we need the books to be exactly right so that we can have a clean slate and a fresh start moving forward,” he said. “We won’t have these problems again.”
Maiellano said that after the cleanup, Elevate CPA, based in Mesa, Arizona, could be retained to review high-level accounting issues and ensure month-end and quarter-end work is complete for future audits and state reviews. Harshbarger said the board would receive a separate proposal for those services. Trustees unanimously authorized her to hire Elevate CPA for the cleanup work.
According to Maiellano, all of the hospital’s financials for fiscal years 2024 and 2025 to date will be fully audited, shored up and prepared for submission to DZA, the hospital’s external auditor, by Dec. 15. DZA will then have eight weeks to audit those financials, certify the information and submit it to the state. The state is currently withholding hospital funds as a penalty and will release that money once WCHS submits its financials. Harshbarger said the state is withholding a portion of the overall reimbursement, but WCHS has retained its mill levy.
“Moving forward, this is simply just not going to happen,” Maiellano said. “There is a month-end close, a quarter-end close process that takes place at the end of the year and within 15 days at the end of the year we will submit our financials to our external auditors for review and submission to the government.”
Maiellano said there were communication “shortcomings” between WCHS and the company that performed the last audit, Washington-state-based DZA. He told the board he would recommend changing auditors in the future but added that internal work was also not completed.
Harshbarger said that DZA admitted it had not notified her regarding incomplete work, and Maiellano said DZA also could not produce records showing it had made requests of WCHS.
“So I blame them just as much as they want to blame us,” Maiellano said.
Harshbarger said that since Maiellano started at WCHS on Nov. 17, the two of them have been “plowing through” the remaining work.
The board split, however, on another financial decision. Members disagreed over whether the hospital should absorb an $11,000 increase in its 2026 employee health insurance premiums or share the cost with employees. Harshbarger recommended that WCHS split the premium increase 50-50. For 2025, total health insurance premiums cost $2.27 million. Employee contributions totaled $399,633, and employer contributions amounted to $1.87 million.
For 2026, the cost for WCHS will be $1.935 million, and in a 4-3 vote, the board chose not to increase the cost for employees. Trustees Ted Ertman, Mary Rankin, William Curley and Dottie Sylte voted to have the hospital absorb the increase. Trustees Kari Drost, Benjamin Roberts and Ann Slagle voted against the motion. Supporters said keeping the rates the same for employees would help retain staff, while opponents voiced budgetary concerns.
Harshbarger said WCHS will stay with BlueCross BlueShield in 2026 because no other option was available, given the timing. Another factor may have been that WCHS has a small risk pool.
Rebecca Mock, director of human resources, said Gallagher, a firm that helps the hospital with employee benefits, reported that WCHS has a 2.8% increase in benefits and advised that moving away from self-funding insurance isn’t financially feasible. She said that with Maiellano on staff, Harshbarger will be better able to evaluate that option in the future.
Harshbarger told the NLJ that an alternative to self-insured plans is fully funded insurance. WCHS offers fully insured plans for health savings accounts, life and disability coverage through The Standard, vision coverage through VSP and dental coverage through Delta Dental. None of those rates will increase in 2026, according to a WCHS 2026 benefit enrollment slideshow Harshbarger shared with the NLJ.
A Health Care Administrators Association article said self-insured plans require employers to pay claims out of pocket rather than paying a fixed premium. Employers typically purchase stop-loss insurance to cover claims above a certain amount.
WCHS receives its stop-loss coverage through Berkley - Clear Lake Captive. The cost of insurance-linked securities premiums will increase 9% in 2026, but aggregate premiums will not increase, according to the slideshow.
The article said self-insurance can be challenging for small employers or those with limited cash flow, but it allows companies to avoid prepaying for coverage and to customize plans to meet employees’ health care needs.
Innova is the company that has taken over billing and collecting from patients, and WCHS is working on a more proactive approach to billing, including collecting co-pays in the office and providing patients with actual costs before they receive services.
“That is not only good for our bottom line, but it’s what we owe our patients,” Drost said. “Cost is a big factor in the decisions they make on what services they receive and for us not to be able to tell them that until later is unfair to them as well.”
Maiellano said at the Dec. 9 meeting that Innova is working on accounts receivable and is receiving details related to third-party payers.
He said WCHS staff are meeting “constantly” with Innova, and he is working to develop real-time dashboards and analytics in an engaging format that the board can use to access accurate information instead of relying on emails and spreadsheets. He said he plans to meet weekly with Innova to ensure timely insurance denials appeals, rebilling and up-to-date accounts receivable.
Drost said that Innova received insurance accounts receivable on Sept. 22 and self-pay accounts receivable in October. Harshbarger said WCHS has $313,000 over 180 days in self-pay, and self-pay is the hospital’s second-highest revenue category. Drost said the goal is to prevent those balances from growing, and Harshbarger said Innova is beginning to handle accounts for patients who chose to pay without using insurance
Harshbarger did say she is concerned about Innova’s ability to meet the hospital’s needs in a timely manner, but noted that the hospital has seen an increase in Medicaid payments received.
WCHS must clarify what portion of long-standing self-pay balances the hospital writes off, for instance, she said. Hospitals often provide discounts on older bills to recover at least a portion of the amount owed, Harshbarger said. According to Harshbarger, the hospital is also developing pre-authorization workflow processes for every department.