NC's new Medicaid payment system a 'nightmare,' some providers say

lbonner@newsobserver.comJuly 20, 2013 

State officials say the new Medicaid bill-paying system is working better than expected. But for the company trying to get kids wheelchairs, the dentist who hasn’t been paid in a month and the providers who wait days to get their calls for help returned, the system is a near disaster.

The state Department of Health and Human Services warned providers to expect a few bumps after the new Medicaid billing system came online July 1. For many, the bumpy weeks have been worse than they imagined, and they have not been told when the frustration will end.

Under the government health insurance program, the state and federal government pay about $13 billion a year to 70,000 health care providers to treat 1.7 million poor, elderly and disabled people. The Medicaid billing system, which DHHS is calling NC Tracks, doesn’t just pay bills. It is the gateway to all kinds of medical services and information that ensures patients are seeing the right doctors and getting approved medicines. NC Tracks is failing in those critical areas, providers say.

“This change with NC Tracks has been anything but successful,” said Susan Walsh, office manager at the Purcell Clinic, a pediatric practice in Laurinburg. “They have serious defects . Practices aren’t getting paid, which is very serious for all of us financially.”

Doctors, dentists, pharmacists, in-home care providers and medial equipment companies say the new software system is riddled with problems. Pharmacists cannot get approval to fill some prescriptions for medicine. Companies submit bills only to learn that they’ve vanished into the system. Doctors’ offices do not have at the ready information they need to know which patients they should treat or whether they need to collect copayments – information the old payment system provided.

Dentists who have treated Medicaid patients for decades have trouble registering special ID codes so they can once again be paid. Topping off the problems, providers say when they call for help they wait on hold for 90 minutes or more, then don’t get their problems solved or can’t obtain information on how long they’ll have to wait for fixes.

DHHS has been hyping the new system for weeks, emphasizing that it is paying provider bills.

Joe Cooper, the information technology chief at DHHS, continued last week to praise the new software, which he said has paid more than 3 million claims since July 1.

“We are processing claims at a very, very high rate,” Cooper said, while acknowledging that the brand-new system presents “a learning curve” for providers.

Cooper said he has sympathy for those providers who haven’t been paid for weeks, but “we have a lot of providers submitting claims and being paid in a very timely manner.”

Project was delayed

The state hired a Virginia-based company, Computer Sciences Corp., in late 2008 to replace a decades-old Medicaid payment system run by Hewlett-Packard, now HP. The project was delayed and costs ballooned. CSC is being paid $484 million for developing the system and running it through 2020.

Among the more serious problems for patients is that access to some prescribed drugs has been severely limited because the mechanism that tells pharmacists it’s OK to dispense them is not working.

The state requires pharmacists to get special permission before they fill prescriptions for dozens of name-brand drugs used to treat ailments from asthma to high blood pressure to seizures.

“There are situations where patients have not been able to get their medication,” said Mike James, vice president of the Association of Community Pharmacists.

DHHS has worked through some early problems where pharmacists were not able to use the new software, James said. But the agency hasn’t told pharmacists when the prior authorization problem will be fixed. In the meantime, the department is allowing patients to get emergency three-day supplies of medicines. But that doesn’t solve the problem for patients or pharmacists who have to decide whether to give patients several more days’ worth of medicine and risk not getting paid, James said.

“The risk they run is that for some mysterious reason, the drug won’t be covered,” he said. “They’re out on a limb.”

Medical supply companies also need prior approval to provide some types of equipment, and they have had trouble getting permission to deliver it to patients.

Paperwork ‘just piling up’

CVC Home Medical in Wilmington provides specialized wheelchairs, cribs and strollers for disabled children. The company hasn’t been able to get its requests for approval through NC Tracks.

The paperwork “is just piling up on my floor,” said Lisa Simons, patient services coordinator.

“I have one child who is just in dire need,” she said, and the state has not been able to give her any answers on when it will be able to approve the equipment.

Calling the help line has been no good, she said. “It takes you in a circle, and you end up where you started with no answer.”

“I called and was on hold for 90 minutes when someone picked the phone up and said, ‘Can you hold on please?’ ” said Walsh, manager of the Laurinburg pediatric clinic. “I said, ‘You’re kidding, right?’ She never picked the phone back up.”

Using the old system, doctors’ offices used to see immediately whether patients were seeing the right primary care doctors under the Medicaid managed care program, Walsh said. The NC Tracks screen doesn’t show that information, she said. If a doctor in the practice ends up treating a patient who isn’t assigned to him, the office will try to get permission later or just eat the cost, Walsh said.

Ricky Diaz, DHHS spokesman, said the call center is getting about 2,500 calls a day, and the time it takes to solve problems ranges from about 2.5 minutes to 2.5 hours.

However, an internal DHHS email said the call center is getting 3,000 to 4,000 calls as day, with an abandonment rate of 56 to 60 percent.

‘Really a nightmare’

NC Tracks is “really a nightmare,” said Beth Bowen, executive director of the N.C. Association for Medical Equipment Services.

“We were expecting glitches,” she said. “We weren’t expecting complete failure of the system here, and that’s what happened.”

The state has placed some of the blame for problems on providers not being trained to use the system. But people who took the classes before the July 1 launch and those who enrolled for training this month say the workshops are inadequate because they don’t address real-life problems.

“The governor’s office is going to start to look bad,” Bowen said. “It’s a very scary situation. People’s jobs are going to be lost, and companies are going to close.”

Providers said the stream of rosy press releases from DHHS glosses over serious problems.

Reading about Gov. Pat McCrory congratulating the department and CSC during a visit to its call center about two weeks ago galled Betty Wallace. She owns Professional Nursing Service, an in-home health service that has hundreds of Medicaid patients as clients. Her company has not been paid in three weeks, and she’s worried about making payroll at the end of the month.

“I have to have money coming in, and we’re not able to get anything through,” said Wallace, whose company has offices in Garner and four other towns. “I’m really panicking because I don’t know what to do.”

Bonner: 919-829-4821

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