The Cook County Health and Hospitals System hired a consultant last year to help improve its billing and collections process.

But Cook County commissioners just found out about it last Thursday, and they want to know why they were kept in the dark, especially because there have been public hearings and an inspector general’s investigation into the health system’s billing woes.

This is what commissioners just learned: The county-owned system hired a prominent national health care consultant called Advisory Board last spring. The firm advises hospitals and health systems nationwide on strategy, billing, and finance as ways to boost their business.

The health system can’t spend more than $779,915 on the Advisory Board’s three-year contract, according to a copy of the contract.

“We should have been told about this,” Commissioner John Daley said last week during a meeting of the audit committee he leads. “There’s money out there that we should be collecting.”

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It’s not clear what’s in the Advisory Board’s report. Commissioners received a copy on Friday, along with a memo from health system Chief Financial Officer Ekerete Akpan. He said they can’t share the report, which is “owned by and under a copyright owned by the author, the Advisory Board, and is provided to CCHHS on confidential and proprietary terms,” the memo said.

The health system would not provide a copy to WBEZ.

At the audit committee meeting, Akpan didn’t explain why commissioners weren’t told about the report. But he apologized to commissioners who were upset about the lack of transparency.

Hill Hammock, chairman of the health system’s independent board, added: “It was a shortcoming. No question about it.”

The independent health system board approved hiring the Advisory Board consultants during a public meeting in April 2017, health system spokeswoman Caryn Stancik said.

The health system’s billing and collection practices have been under a microscope for months. In March, Cook County Inspector General Patrick Blanchard issued a blistering report. The health system failed to collect at least $175 million in 2016 and 2017 because insurers denied the county’s claims because of everything from not registering patients correctly to doctors not documenting treatment properly, Blanchard found.

That’s not a unique pain point to the county health system. Hospitals nationwide are grappling with this issue.

The county health system countered that Blanchard didn’t interview the system’s top financial leaders and that the system is undergoing fast-paced change. It is used to submit patient bills to mainly one payor — the Illinois Medicaid health insurance program for the poor and disabled.

But now, the system bills private insurance companies, too, because Illinois Gov. Bruce Rauner has largely privatized Medicaid. That’s made the process more cumbersome.

(The health system’s insurance plan, CountyCare, is among the private Medicaid insurers).

Despite the uncollected bills, the county taxpayer subsidy for the health system has declined about 75 percent over nearly a decade. That’s according to health system CEO Dr. Jay Shannon.

Back at the audit committee meeting, Akpan told county commissioners that the health system has implemented some of the Advisory Board’s recommendations. For example, more than 200 employees have been retrained on registering patients.

“Physicians, providers, staff … are aware of some of these changes we’re making,” Akpan said.

Inspector General Blanchard said during his office’s investigation, he learned about an outside vendor the health system hired to provide software to better track denials.

“We were not aware of any further substantive aid or assistance being provided,” he added.

Kristen Schorsch covers Cook County politics for WBEZ. Follow her on Twitter at @kschorsch.