New Medicaid rules creating headaches for adult care homes

Medicaid eligibility changes leave adult care homes scrambling to pay their bills

lbonner@newsobserver.comJanuary 18, 2013 

Recent state changes to the eligibility rules for Medicaid patients has left adult care homes scrambling to pay their bills after their claims for payments were rejected.

About 70 percent of adult care homes that submitted claims this month had them rejected, said Janet Schanzenbach executive director for the N.C. Association (of) Long Term Care Facilities.

"The billing process there is a disaster," she said, referring the state’s Medicaid billing system.

Long-term care facilities say that Medicaid pays about 40 percent of patient expenses. “How are they going to make payroll?” Schanzenbach asked.

The problems stem mostly from a failure to correctly fill out new forms that are required to receive payment.

The state Department of Health and Human Services worked with Hewlett Packard, the company that runs the Medicaid billing system, to offer training on how to properly complete the new form, said agency spokeswoman Julie Henry. Many adult care homes had been omitting information required to process the claims.

The department could not determine what percentage of adult-care claims were rejected, but the number was significant, Henry said.

Some of those rejected claims will likely be paid next week, Henry said, after adult-care homes resubmit their bills.

The problem comes as DHHS wants to spend less time and money updating the old billing system to focus on getting a new one working.

The state has hired a consultant to make sure that the state’s new software is ready to use by July.

Susan Young, a risk management specialist from Charlotte, is working to smooth the transition away from the existing billing system to the new system being built by Computer Sciences Corp.

The new system is years behind schedule, and the contract cost ballooned to $495 million, up from the original $287 million.

Al Delia, former acting secretary in the state Department of Health and Human Services, put most of the blame for cost increases and delays on constant software updates forced by changes in state and federal Medicaid laws. Changes to the existing system were being made alongside changes to the new one.

DHHS announced on Friday that the agency’s new leader, Dr. Aldonas Wos, told HP to stop making updates to the existing programs while the department concentrates on getting the CSC system ready.

“In the coming weeks and months, our department’s priority is to ensure the transition from our current Medicaid system to the replacement MMIS [Medicaid Management Information System] is smooth, efficient and on time,” Wos said in a statement.

Young started work two days after Gov. Pat McCrory was sworn into office. She’s working on a $99-an-hour contract through Feb. 1, with costs not to exceed $20,100.

The existing computer system processes 88 million Medicaid claims a year, and writes more than $11 billion in checks to 70,000 health care providers. The federal government is paying 90 percent of the cost to build the new system.

Bonner: 919-829-4821

News & Observer is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service