Medicaid payment

Wednesday, November 01, 2017 12:36 PM

CMS pushes for immediate payment and interest on overdue clean claims

by Kate Alfano, CMS Communications Coordinator

Ongoing issues with Colorado’s new Medicaid vendor – DXC Technologies – since its rollout in March has left many practices in a dire financial state as some wait for hundreds of thousands of dollars in claims to be paid. The Colorado Medical Society is looking to the state and its leaders to diminish the harm and has been conveying physician concerns to state agency leaders and legislators.

CMS has been in discussions with the Colorado Department of Health Care Policy and Financing since the summer and put concerns in writing on Sept. 1 with a strongly worded letter to HCPF Executive Director Sue Birch, MBA, BSN, RN. Cosignatories of the letter included 16 other state and regional provider organizations.

CMS expressed doctors’ frustrations with lengthy payment delays for the care and treatment of Medicaid enrollees – and asked for payment on clean claims as soon as possible, plus interest and penalties.

Since enactment of the American Recovery and Reinvestment Act of 2009, federal law requires state Medicaid programs to pay 90 percent of clean claims within 30 days of receipt of the claim, and 99 percent of clean claims within 90 days of receipt of the claim. Additionally, the Colorado statute concerning the Prompt Payment of Claims recognizes that the delay in payment of claims causes an unwarranted drain on the financial resources of health care providers and requires the payment of not only interest but a penalty as well. As a financial hardship has clearly been demonstrated to be the case for some physicians, CMS is asking the state to pay not only interest but also penalties.

Director Birch responded on Sept. 6, apologizing for the billing problems doctors have experienced and committing to resolving these issues, as it is the agency’s “responsibility to provide timely reimbursement for properly submitted claims.” Birch’s response left unanswered questions, however, and CMS submitted a follow-up letter on Sept. 18 asking for clarification and additional information.

“The payment system conversion has caused practice disruption for many of our members and the patients they serve,” wrote CMS President M. Robert Yakely, MD, in the Sept. 18 letter. “We continue to hear from more member physicians regarding burdensome and costly steps that they are having to take in order to cope with payment problems associated with the conversion. Importantly, we are also hearing from more physicians that have exhausted their efforts and opted to just quit being Medicaid providers.”

In an August interview with Colorado Public Radio, then-CMS President Katie Lozano, MD, FACR, said, “The system crash currently underway threatens the Medicaid program’s credibility and reliability to thousands of doctors and other health care providers who treat Medicaid patients.” These are not mere inconveniences; “economic disruptions of this magnitude threaten the economic stability of medical practices that by definition operate on thin margins. This situation, in turn, could rip wider holes in Colorado’s fragile safety net system of care for the working poor.”

Chris Underwood, HCPF health information office director, says they have not seen providers leave Medicaid “yet” and are optimistic the department can work through remaining claim denials so providers can continue to see Medicaid clients. He said the top reason for denial is because of provider enrollment errors: either the physician doesn’t have an enrollment record on file or the information used in billing does not match their enrollment record. He requested more feedback and details from stakeholders on claim denials that providers think should be paid.

The coalition of provider organizations, which includes CMS, continues the discussion in the legislature, raising alarm bells on the severity of this problem. In addition to the interest and penalties, the coalition has pushed for legislative oversight and for the Medicaid Department to set up a “red team” comprised of DXC, HCPF and providers to identify problems with the claims IT system, clarify timelines for various fixes and better communicate ways to address common problems, and triage system fixes. “We’re hopeful this approach can accelerate the pace at which claims issues are resolved for practices,” said Ryan Biehle, MPH, MPA, deputy CEO for policy and external affairs of the Colorado Academy of Family Physicians.

To contact HCPF with concerns and issues, go to www.colorado.gov/hcpf/provider-help for a list of contacts. For comments on your experience with Medicaid payment, email president@cms.org.