Problems remain with NC’s Medicaid payment system

by Lynn Bonner, Charlotte Observer, November 20, 2013.

State officials said the troubled Medicaid billing system NC Tracks is operating more smoothly, but lawmakers said it still has significant problems.

Doctors, hospitals and others who treat Medicaid patients began complaining about a new computer system as soon as the state started using it July 1 to pay health care bills. State officials have worked to reassure health providers and legislators that it is fixing problems and sending providers their money.

“I continue to stress to our team, and our vendor, that we must get providers paid for the work they do,” DHHS Secretary Dr. Aldona Wos told a legislative committee Tuesday.

Some areas of concern remain, she said.

“We are forcefully addressing these issues, and although progress is being made, we will not rest until all issues are resolved. I assure you that where necessary, I will hold people accountable.”

So far, the state has charged the contractor, Computer Sciences Corp., about $250,000 in penalties related to problems with the call center and delays in approving treatment, said Joe Cooper, DHHS technology chief. Phones at the call center no longer ring endlessly, Cooper said, though complaints about call center workers not returning calls and their inability to answer questions continued.

The knowledge of call center workers is increasing with experience, he said, and CSC put in a new process last week that requires workers to tell callers when they’ll get answers. CSC is providing online and in-person training and is talking to different medical associations about fixes.

Medicaid payments to providers are about the same as under the now-retired system, but many claims are still not being approved. Over four months this year, $3.236 billion was paid out versus $3.252 billion over the same time last year. About 1.6 million elderly and disabled people, low-income children and pregnant women are enrolled in the government insurance program.

But the new computer system is not approving claims from dentists, doctors and other professionals at the same rate as the old. For the week of Nov. 1, nearly 66 percent of those professionals’ claims were approved, compared with 78 percent the previous year. About 87 percent of dental claims were approved under the new system, while the old system approved more than 97 percent. The system was supposed to make payments on a more regular basis than the old.

NC Tracks is doing better with hospital and pharmacy claims. But legislators said they were still getting calls from companies that provide medical equipment such as wheelchairs and artificial limbs, saying they’re not being paid for devices critical to patients’ well-being.

“We’re talking about people’s oxygen and priorities they rely on for their lives,” said Sen. Tamara Barringer, a Cary Republican.

Sen. Tommy Tucker, a Union County Republican, said he was more comfortable with the new system. But Senate Minority Leader Martin Nesbitt, an Asheville Democrat, questioned whether the numbers DHHS presented offer useful information.

“I may be missing something, but I don’t see the progress,” he said, referring to a chart on percentages of claims paid. “From these numbers and what I’m hearing here, I don’t think we’re fixing the problem.”

Cooper said a series of new goals for NC Tracks will be set in December.