Businesses say North Carolina Medicaid billing problems could close their doors

Some say they're owed hundreds of thousands of dollars, forcing them to take out loans and cut employees
October 9, 2013 4:03:25 PM PDT
A day after North Carolina state lawmakers and medical workers demanded quicker resolution of problems within the state's new Medicaid billing system, some Triangle area businesses told ABC11 Wednesday they could be forced to close their doors if the situation isn't resolved.

Tuesday's hearing at the General Assembly focused on the NCTracks computer system, which has been blamed for claims payments that are months behind.

Department of Health and Human Services officials and the contractor that built the program told House and Senate members they were making good progress in helping medical providers navigate the system. They said NCTracks was largely doing what it's supposed to do - taking claims and paying tens of thousands of hospitals, doctors and pharmacists that help treat 1.7 million Medicaid patients statewide.

But that's not what some medical practice administrators say. Some have been forced to take out loans or stop seeing new Medicaid patients until they're reimbursed. Administrators of small medical practices said they were waiting on hundreds of thousands of dollars of pending claims.

ABC11 spoke Wednesday with Healthcare Equipment in Durham. It's a small company that makes a big difference in people's lives - offering custom made medical equipment - mainly wheel chairs and beds - for people who often have severe disabilities.

Owner Larry Lankford said the problems with the Medicaid payment program could force them to close their doors after 35 years in business.

"If we don't get paid, all these services will stop," he said.

Lankford said about 50 percent of his income comes from Medicaid. Since NCTracks went online July 1, payments have been few and far between. He's now owed about $300,000.

Lankford said he has gotten about a $100,000 in what the state calls hardship payments - money to keep businesses like his running as the kinks get worked out of NCTracks. But he says that covered old expenses and now - because he got that money - he's not getting any more.

Tuesday's testimony at the General Assembly about how much in hardship payments had been given out is also concerning to Lankford. The number started at $65 million, then dropped to 51 and ended at $15.1 million after some probing of three DHHS officials by lawmakers.

"All three should have told us the same number, the exact same number, and that's not what we heard," said Lankford.

During their testimony, DHHS officials told lawmakers all the kinks in NCTracks will be worked out soon and the payment backlogs cleared up by the end of the year.

At Heathcare Equipment in Durham, that optimism is not shared.

"That's not what I expect will happen. I expect this to be years in solution and resolving these issues," said Lankford.

When DHHS chief information officer Joe Cooper said Tuesday it would be three to six months before the remaining defects in the computer program will be resolved, one key legislator said a vague timeframe wasn't good enough.

"Saying three to six months is just not acceptable because the users can't go on doing this," said Sen. Jeff Tarte, R-Mecklenburg, who has built similar health care billing systems in the private sector.

Cooper, a longtime IT executive brought in by DHHS Secretary Dr. Aldona Wos, said more detailed information would be available. While Cooper said system data shows the program moving in the right direction, the nature of a billing system means adjustments will have to be made for years to come.

Senate Minority Leader Martin Nesbitt, D-Buncombe, was incredulous when Cooper told him that he expected "virtually all providers to be successfully submitting claims" by the end of November. Providers who have been filing claims correctly for three months are still getting denied claims, Nesbitt responded.

"The focus needs to be we're off track and it has to work - period," said Rep. Susan Martin, R-Wilson, adding "I just am not confident that I hear the sense of urgency."

NCTracks replaced a billing system originally built in the late 1970s. The project has been marked by cost overruns, a stinging audit and a canceled contract with another provider before CSC took it over in 2008. CSC is getting paid $484 million to build and operate the system. Most of the price tag is being paid by the federal government.

"This is an enormously complicated system and it is our obligation to make sure that every single provider in this state is paid appropriately for the services that they are rendering to the citizens of our state," said Wos, who arrived with Gov. Pat McCrory's administration in January. "This takes time, it takes patience."

Associated Press Reporter Gary D. Robertson contributed to this report

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