@NCCapitol

@NCCapitol

DHHS staffers lay out progress on Medicaid billing system

Posted November 19, 2013
Updated November 20, 2013

— State health officials tried to reassure lawmakers Tuesday that the much-maligned NC Tracks system that helps the state handle Medicaid billing is getting better and service providers are getting paid.

Department of Health and Human Services Secretary Aldona Wos began her remarks to the legislative oversight committee with a mention of the Medicaid Advisory Group, formed since her Oct. 8 grilling by lawmakers. That group includes industry experts and lawmakers working on recommendations to reform the state's Medicaid system.

"We are moving forward," she said.

Wos  noted the continuing concerns, raised by doctors, hospitals, medical device providers and others, about NC Tracks. Providers have complained for four months that the system isn't paying them as quickly as it should.

In last month's meeting, legislators peppered DHHS leaders about complaints concerning delayed or rejected claims, unhelpful call center workers and complicated medical coding.

"We must get providers paid for the work they do," Wos said.

Agency leaders said they were working to fix problems but said some defects would take up to six months to resolve.

"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," she said.

But DHHS Chief Information Officer Joe Cooper said the technology is not solely to blame for delays associated with NC Tracks. 

"The vast majority of claim denials are tied to the wrong taxonomy being used by the provider," Cooper said.

DHHS has deployed people across the state to to work one-on-one with doctors who aren't being paid correctly. Claims are being processed faster, and backlogs are dwindling, he told lawmakers.

"We've made a huge amount of progress, but we still have more work to do, particularly around the professional providers," he said.

Medicaid is a health insurance program that covers roughly 1.6 million of North Carolina's 9 million residents. The bulk of those served are children or the parents of children from low-income families, along with pregnant women, the elderly and disabled.

NC Tracks was designed to streamline provider payments, spot Medicaid fraud and provide state-level policy makers with detailed data on how quickly public dollars are being spent on the program.

While there are still fixes that need to be made, Cooper said, North Carolina's roll-out has gone more smoothly than similar networks did when they were put in place in other states.

"Our trajectory is good," he said.

Members of the committee appeared to be unsatisfied with the answers they were getting.

Wake Republican Sen. Tamara Barringer said she's still getting desperate calls from medical equipment providers who can't pay their bills. Senate Democratic Leader Martin Nesbitt said the data refutes Cooper's claim that progress is being made. He asked for an independent report on the program. 

“From these numbers, and from what I’m hearing here today, I don’t think we’re fixing the problem," Nesbitt said. "We’re just generating more and more bills aren’t being paid.”

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  • HeadsUp Nov 21, 2013

    Some IT contractors are much better than others. Google "CSC air force contract."

  • ajarvis1267 Nov 21, 2013

    HeadsUp: MMIS systems are built based upon the requirements defined and approved by the state agency in charge.

    As in the case with ACS/DHHS in 2006, the challenge was DHHS did not stick to their own RFP or contract documents, heaping "extra" needs/wants on top of the core MMIS ACS was to build. It is likely considering the negligible contract management oversight at DHHS, they did the same to CSC, heaping unnecessarily complex requirements on what is already a complex system to begin with.

    In other words, Garbage-in, garbage-out. The garbage likely came from DHHS.

  • HeadsUp Nov 21, 2013

    Wos won't resign, and McCrory has $261K reasons not to fire her.

    Pat should never have hired someone he couldn't fire, especially such a huge contributor.

    Yet another sign of Pat McCrory's abyssmally poor judgment.

  • junkmail5 Nov 20, 2013

    "the VASTLY less efficient private-insurance system IN THE US "

    And the web site that was built be the government is efficient? Crazy!
    redwolfone

    You seem to have confused "insurance" with "web development"

  • junkmail5 Nov 20, 2013

    What is your metric of efficient- redwolfone

    They get equal or better life expectancy and healthcare outcome.

    And they spend roughly 1/3 to 1/2 what we do total (per capita) to do it.

    AND they cover EVERY citizen in the process which we don't.

    My data is literally every single bit of data available on the topic. There's mountains of it.

    For example the WHO ranks us -38th- in the world in healthcare outcomes.

    But we're #1 in spending by a HUGE margin.

    Which specific part do you need MORE on?

    our health system is the best in the world - lessismore

    No, it's not. It's not even close to #1 by any broad statistical measure available.

    Again- 38th in the world per the WHO. The ONLY place we're #1 is spending.

    Have you seen the public hospitals in England? Or the waiting list if your over 50 in Canada?
    redwolfone

    Yup... and they STILL prefer their system 9 to 1 over ours, and STILL live longer... all while spending FAR less to do it.

    Amazing huh?

  • redwolfone Nov 20, 2013

    "the VASTLY less efficient private-insurance system IN THE US "

    And the web site that was built be the government is efficient? Crazy!

  • redwolfone Nov 20, 2013

    "I can't believe Aldona Wos hasn't resigned yet."

    No one is ever going to resign. That is Big Government. Do a half baked job and get promoted. What would get you fired and a bad name in an industry in the private sector would gain you job security and a raise in the Federal Government. Its a joke!

  • redwolfone Nov 20, 2013

    "the VASTLY less efficient private-insurance system IN THE US that I contrasted to that in other nations which are MUCH more efficient isn't talking about the topic?"

    What is your metric of efficient and where is your data...???? Have you seen the public hospitals in England? Or the waiting list if your over 50 in Canada?

  • lessismore Nov 20, 2013

    Junkmail....our health system is the best in the world and Obama and his communist supporters didn't have to destroy it in 6 weeks, leaving millions without any insurance at all. Changes could have been made to help those that needed help, but to destroy the entire system was narcissistic. When one man believes he is God and knows the easiest way to control people is to control health care, and you follow him blindly.....this country is doomed.

  • junkmail5 Nov 20, 2013

    Junkmail.....we are talking about the US gov't

    Ohio and Arizona aren't in the US anymore?

    the VASTLY less efficient private-insurance system IN THE US that I contrasted to that in other nations which are MUCH more efficient isn't talking about the topic?

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