Frustrated providers mull suit over Medicaid claims system
Posted August 2, 2013
Raleigh, N.C. — 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."
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.