The new system North Carolina uses to process Medicaid payments is still a nightmare for many providers. That's one of several controversies that legislative oversight committees focused on Tuesday in Raleigh. Lawmakers also found out more about food stamp delays. And they directed pointed questions at Secretary of Health and Human Services Aldona Wos and her top staff.
Sandra Jarrett is having an awful time with the new system for Medicaid providers.
She's a manager for Salisbury Orthopaedic Associates, and she's a leader of a state association of medical group managers. She's heard from providers who have too many problems to count with the system the state rolled out in July, called NC Tracks.
“The issues alone have wreaked havoc on our ability to manage our revenue cycles,” Jarrett said. “It has single-handedly brought our medical practices to the brink of dropping out of Medicaid or even closing doors altogether.”
Jarrett was one of about a half dozen providers who spoke during the legislative meetings. Almost all of them brought up how terrible the call center was that was supposed to help with the transition.
They also described confusing payment denials. Sandra Williams is the chief financial officer for the Cape Fear Valley health system. Here's an example she gave about one denial that asked for more information:
“The additional information that was requested was to include the weight of the newborn and then resubmit the claim,” Williams said. “The patient was born May 11, 1955.”
Those kinds of glitches are keeping providers from getting paid. Kimberly Lynn is a manager for a medical equipment company near Greensboro.
“We are 90 days into this, and we're still struggling to coordinate our billing and get paid,” she said. “The software provider that we use, they have told me that they've done over 30 Medicaid transitions throughout the states, and this is the worst they've ever seen.”
A company called CSC is behind NC Tracks and the call center. Mike Gaffney is a company vice president.
“Many of these issues are due to the fact that NC Tracks is different from the legacy system,” he said. “Unfortunately across the state, less than 10 percent of the provider community took advantage of training prior to July 1.”
Gaffney did acknowledge his company has plenty of work left to do to fix the problems.
Leaders from the state Department of Health and Human Services said they have their work cut out, too. Joe Cooper is the department's chief information officer.
“About 90 days after NC Tracks went live, many providers are still having difficulty fully transitioning to the new system,” he said. “And though fewer than 2 percent of providers haven't received any payment at all, this number is totally unacceptable.”
But Cooper argued that North Carolina is doing better than New Hampshire or Georgia did when they changed their old systems – basically, it could be worse.
He said the state has penalized CSC $56,000 so far for not meeting its contract, and that the company and the state are fixing the problems.
“We expect virtually all providers by the end of November to be successfully submitting claims,” Cooper said. “We will have problems for months to come. But our focus is on the providers and getting them paid.”
The legislative oversight committee also asked health and human services leaders about another new system with problems, NC FAST.
Since March, every county has had to use that electronic system for food stamp applications. Wayne Black is state social services director.
“When you consider that in our county (Departments of Social Services),” he said, “they handle 45,000 new applications a month, and complete 100,000 to 110,000 recertifications per month for food nutrition services, you can imagine that a backlog would be formed.”
And it did. Families in some counties have had to wait more than two months to get food stamps. That's because of problems with IT systems during the rollout and also because some counties just didn't have fast enough Internet connections.
Black said the state has hired more than 160 extra staff to help get rid of the backlog, and it's working. But he couldn't say how soon the delays will end.
That frustrated Rep. Beverly Earle, a Democrat from Mecklenburg County.
“I understand that this has not been the disaster that Tracks tends to still be,” she said. “But to go months with people not getting food stamps to me is not acceptable.”
Secretary of Health and Human Services Aldona Wos responded, “We wish we could have it perfect, but there's no way of knowing that ahead of time or ensuring that it will be.”
Wos took more pointed questions from lawmakers about raises her department has given some young staffers who worked on Governor McCrory's campaign last year.
“We have teachers with 5 years of experience making $30,000 a year and have not received a raise in five years,” Sen. Tommy Tucker, a Republican from Union County said. “Yet you go hire someone who is one year out of college with an English major and pay him $85,000.”
“You need to tell me how I'm supposed to respond to people when the press picks up on that, and it's public record, and we're getting killed over it,” he continued.
Wos responded, “Senator, my heart goes out to you and to the teachers, which you have mentioned.”
She went on to say that she hires the right person for the job and gives him or her a salary that's line with their predecessors. Sen. Tucker then asked that in the future, she keeps in mind how that salary might look to the people of North Carolina.