Area providers hurt by Medicaid reimbursement system defects

Issues with a new statewide system that handles Medicaid reimbursements has hit Western Slope health care providers hard as many are waiting on hundreds of thousands — and in some cases millions — of dollars in claims that have been denied since the system launched in March.

Health providers such as local hospitals and private practitioners who accept Medicaid have begun complaining to state legislators and say the system has improved over the past month, but they are still waiting on some reimbursements and are left wondering if they will ever see all the money they are owed.

At Grand Junction’s Community Hospital, Chief Financial Officer Ed Johlman noted the strain on his administrative staff during the past six months and that after two months, the hospital saw its accounts receivable double to more than $5 million in Medicaid claims that were not yet paid.

As a large health provider, the hospital had enough savings to make up for the shortfall and in the past month or so, that number has shrunk to around $1 million. Despite not struggling to make payroll as others have, Johlman said it created a big problem and put a halt to productivity. He credited staff for helping to get through the worst of the matter.

“There’s still a lot of claims, but we have a contact at the state we can email. We’ve made a lot of progress in a couple of weeks,” Johlman said. “It took a lot of diligence on staff to stay on hold for hours and work as many accounts through as possible.”

Other facilities have also noted that their staffs are overworked as they have been resubmitting claims that were denied as well as filing new ones and spending hours on the phone trying to push claims through.

“From an administration standpoint it’s a significant concern with just the time staff spends working on this issue,” Delta County Memorial Hospital CEO Jason Clecker said. “There’s a big cost to that.”

Clecker said that between 25 percent and 27 percent of the hospital’s revenue each month comes from Medicaid reimbursements, making for some lean months since the new system — run by DXC Technology in an attempt to modernize the service — went into effect March 1.

Delta County Memorial Hospital physician billing manager Darla Ballard said the process has gotten better as they’ve been receiving payment for more and more claims and have had better luck in contacting those at the Colorado Department of Health Care Policy and Financing, but the frustration has been palpable for half a year.

“It’s just becoming a normal process that is super frustrating. It could be 100 percent easier than it is,” Ballard said. “It’s become a full-time job for half of my staff.”

In Montrose, about 60 percent of Pediatric Associates LLC’s patients are on Medicaid and the practice had about $124,000 in claims that were denied. Practice administrator Amber Hickert said Pediatric Associates took some interim money offered by the state to help them get by until the issue is resolved and full payments could be made.

Hickert called the situation “three months worth of pain” and wished the state would have rolled out the new DXC Technology system more slowly to work out the kinks.

Some of the confusion has been in regard to providers having to re-enroll in the Medicaid system and a change in codes that may have also led to some of the denials. The problem was exacerbated by a flood of calls and state staff only being able to push through a small number of claims, even after being on the phone with a provider for hours.

“It’s fair to say it’s been a rough implementation. Providers have struggled with this,” said Rocky Mountain Health Plans Associate Vice President Patrick Gordon.

The insurance provider has helped by serving as a liaison between health care providers and the state and Gordon said the state is working diligently to fix the issue as best as possible.

“It’s been tough, but I’m just very pleased that providers are continuing to see Medicaid patients and I’m pleased the state has pretty much owned the issue,” he said.

State legislators have gotten involved as well and have met with local providers and discussed the matter at a Sept. 20 Joint Budget Committee meeting in Denver.

State. Rep. Dan Thurlow, R-Grand Junction, met with nearly 20 providers in late August when he was first made aware of the situation. Thurlow said that he believes the system will work in the long run — noting that several other states already use the same system — but unfortunately there is no easy fix at the moment.

“At this point, the only solution is to keep working with them,” he said. “Providers will have to keep doing extra work. There’s no easy fix.”

At the Joint Budget Committee meeting, it was noted that the system is now paying approximately 66 percent of Medicaid claims and the hope is to reach 75 percent.

That didn’t sit well with State Sen. Kerry Donovan, D-Vail, who has also met with several health providers in western Colorado.

“I don’t think that is an acceptable goal line,” she said, adding that she hopes the system will be resolved quickly. “It’s not at an acceptable level now, so we have to fix it quickly. And we also need a game plan so these hospitals can provide care for people in Colorado.”


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Is there any system the State of Colorado has “rolled out” that has not had major problems?  Each one seems to have major problems, problems which will probably never be fixed.  It may be time for the legislators to begin asking why that seems to be the case across the board.  Which individual is in charge of making the decision to “roll things out” and does he hold the vendor of those systems accountable if they don’t work as “promised”.  There seems to be none of the latter, thus denoting that those in charge have neither the qualifications nor competence to make those decisions.

Do you see now why Colorado Care that would have put every resident in the state on one computer system for healthcare and for payment to providers was such a bad idea?

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