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Frustrated providers mull suit over Medicaid claims system

Posted August 2, 2013

— Exasperated health care providers are discussing filing a lawsuit against North Carolina over the lack of reimbursement for claims filed with the state's new Medicaid billing system.

Some providers at a Thursday training session in Raleigh said the state owes them as much as $130,000 since the NCTracks system was rolled out on July 1.

"A lot of providers are in dire straits," Knicole Emanuel, a Medicaid attorney, said Friday. "People are losing their jobs, and providers are having to take out loans, and these are all considered incidental or consequential damages."

Emanuel said she's been contacted by almost 100 providers about problems with NCTracks, and a growing numbers are considering a possible lawsuit.

NCTracks, which replaced a 35-year-old computer system, uses different identification numbers for various products and services than the old processing system, and the billing software some providers use isn't compatible with the new numbering system, according to state Department of Health and Human Services officials.

Another issue keeping providers from getting paid is that they have not updated their electronic fund transfer information in the new system, which requires electronic reimbursement of claims.

Sharon Lubbers, who owns Medical Equipment Distributors in Raleigh, said she has about $60,000 in unpaid claims, and contracts approved under the old billing system aren't being honored.

"We're into the second month, and I just don't see these problems being solved, and I'm very concerned about it," said Lubbers, who isn't among the providers considering a lawsuit. "I'm a small-business owner. I employ 12 people, and I have to pay those people."

Department of Health and Human Services, DHHS generic DHHS says it's working with providers to solve problems

Dr. Spurgeon Webber, a Charlotte dentist with five practices, is considering suing. He had to lay off staff and temporarily close one of the offices because of more than $700,000 in unpaid Medicaid claims.

"You have to do what you have to do to cut your costs when you have expenses but don't have revenue coming in," Webber said.

DHHS spokesman Ricky Diaz is approving about 57 percent of Medicaid claims, compared with 59 percent under the previous system. He said he expects to have most, if not all, of the issues resolved in the next 60 days.

"Each day continues to improve as we continue to hold training sessions around the state," Diaz said. "We continue to proactively reach out to providers who are having difficulty and make sure they're getting paid."

Last week, the agency cut checks to providers having difficulty with their electronic transfers.

NCTracks has processed claims totaling about $38 million for about 900 providers without any problems, officials said.

Emanual said federal Medicaid law requires that 90 percent of "clean claims" must be paid within 30 days. The courts will likely have to determine whether problems with NCTracks means claims don't fall under that requirement, she said.

7 Comments

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  • almagayle50 Aug 8, 2:54 p.m.

    The pharmacies are having a very hard time too, except that it's the recipient who is pinched. My son's depakote, used to treat seizures, is not supposed to require preapproval. Still NC Tracks has not approved it twice - $600 out of pocket. I don't know what folks who don't have the money are doing about there essential medications. I assume the trips to emergency rooms are going way up, for a cost to the state far more than approval of the prescriptions.

  • edmarc49 Aug 5, 12:44 p.m.

    What caused the problem is not any provider seeing Medicaid patients, that is a seriously stupid comment. Medicaid patients have to be seen by providers, and there is nothing wrong with that. What is wrong is not getting paid for doing what is a tough job, filled with paperwork and difficult cases.

    What caused the problem is the wrong company getting the NC Medicaid contract for 500 million and the State Auditor's report on the fact that CSC would not be ready being ignored by the current administration. That is what caused the problem. The vast majority of practices have jumped through every hoop that the new system has demanded, yet no one has corrected the problems at the State's end. It is intolerable to go through all this extra effort, with some forms actually lost by CSC, and then still not get paid when you have resubmitted the same information you did in March and April. Offices could close and patient care is being affected by this nonsense. It needs correction ASAP.

  • whatelseisnew Aug 5, 9:35 a.m.

    "I am all in for a class action suit. It has been 50 days unpaid for my practice and I am not a big practice. I can not handle taking on anymore debt."

    Want to see who caused your problem? Look in a mirror. I have always said if anyone relies on Government for their well-being, then that person is being foolish. Apparently, you have mostly relied on Medicaid patients and that is the real source of your problem. Maybe you should have had many more patients that had insurance from some of those evil private insurance companies. Not to say, you should not be paid for actual services you rendered, you should, but you put yourself in this position, not the State.

  • superman Aug 5, 8:47 a.m.

    So maybe next year when we file our tax return we should sue IRS if they slow sending our refund. If it isnt your ballgame you cannot control the game. Follow the rules. If you dont file your taxes correctly you dont get a refund. Why do people always think they are special?

  • LuvLivingInCary Aug 5, 8:40 a.m.

    notice no mention of CSC which is the contractor the state hired five years ago to implement this system for over $600 million dollars.

  • stymieindurham Aug 2, 6:42 p.m.

    "Dr. Spurgeon Webber, a Charlotte dentist with five practices, . . . "
    ============================================================
    ===

    How in the world can a dentist work in 5 different offices??? Ohhhhh! So, Medicaid is a "for profit" venture???

  • dagmudos Aug 2, 6:42 p.m.

    I am all in for a class action suit. It has been 50 days unpaid for my practice and I am not a big practice. I can not handle taking on anymore debt. We are closing before the month is over. NC Tracks has no resolution team. They can not resolve anything.
    Read this and tell me is this prophetic or just common sense?

    http://www.bizjournals.com/triangle/news/2013/06/19/medical-billing-consultant-ncs.html?page=all