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More than two months after launch, Medicaid providers are reaching the end of their tolerance for the new NCTracks computer system.
By Rose Hoban
During the final week of August, Jordan Karimi was spending his days cleaning up the office, making final phone calls and saying goodbye to employees.
Karimi, 28, had worked for his parents for the past five years. Their small company, Right at Home, had provided home health and personal care to the elderly and people with disabilities in and around Granite Falls. Karimi handled the billing.
But now Karimi is out of a job and his parents are out of business after a decade. The reason? They weren’t being paid for the Medicaid-reimbursed services they delivered in July and August, after the state rolled out its new Medicaid payment system, known as NCTracks.
“It’s just all financial,” Karimi said in an interview in late August. “We can’t even make our payroll; we’re a week and a half behind and we need that money.”
Karimi and his parents are among the many Medicaid providers who say their businesses are increasingly in jeopardy as a result of computer glitches, delays in getting responses and payment problems generated by the new half-billion-dollar computer system.
From individual physician practices to large metropolitan hospitals, Medicaid providers around the state are finding themselves asking their bankers for loans or lines of credit, using up reserves or, as in Karimi’s case, folding up shop since the computer system came on line.
“The economy is not great at the moment,” said Karimi, who was unsure what he’d do when he joined the ranks of Caldwell County’s 9.9 percent of the workforce unemployed. His parents’ company employed about 40 people.
“We were ignored, basically,” Karimi said. “We called – we’re still calling; we called this morning, even as the movers were cleaning out the office.
But they never got results.
During an Aug. 23 meeting of the Medical Care Advisory Committee, a federally mandated committee of Medicaid providers from around the state, Medicaid officials said that hardship payments were available for providers who were having trouble getting paid by the system.
“That’s the first time I’ve heard about it,” Jean Kirk, head of N.C. Foot and Ankle Society, an umbrella group for podiatrists, said during the meeting.
Kirk said podiatrists – who are important caregivers, especially for patients with diabetes whose circulation problems mean they have multiple foot problems – have been calling her for help in getting paid by NCTracks.
Kirk said doctors treating patients who qualify for both Medicare and Medicaid have been having a particularly hard time getting reimbursed for care.
“The Medicaid part of the bill is not getting paid,” Kirk said. “We’re talking about people who don’t have that money to spare, so the docs can’t bill it to the patient. That would be a violation of the Medicaid contract.”
She said she’s heard from dozens of podiatrists who haven’t been paid since NCTracks went online on July 1.
“I also have providers who haven’t been paid since June, and even May, because they were told to hold off on billing in late June as they got the system ready for transition,” Kirk said.
“No one I’ve talked to has gotten a callback from a supervisor, even after they reach someone at NCTracks,” she said.
That’s a complaint shared by James Cowart, who runs a business that provides intravenous medications in the home. His company also frequently bills for patients who are dually eligible for Medicaid and Medicare.
NCTracks has been paying for the drugs, Cowart said. “But there’s no profit in it unless we can bill for supplies and mixing the drug and for nursing time.”
But since the end of June, he said, Medicaid hasn’t been paying for any of that.
Cowart has been back and forth with NCTracks over a “clearinghouse supplier letter” that he was told is required for his bills to move through the system.
“So I called the clearinghouse I use and they said they’d never heard of such a thing,” Cowart said.
His office manager then called the NCTracks contractor, Computer Services Corp. (CSC), and spent 38 minutes on hold only to learn that they had never heard of the clearinghouse supplier letter either.
“And that was just today’s incident,” Cowart said. “Our billing company had 100 rejections on our provider number, all in the past seven days.”
He estimated that he bills for about $100,000 a month, much of it to Medicaid, and is down between $40,000 and $50,000 a month since July.
And it’s not just small providers who are having trouble.
In an interview last week, WakeMed CEO Bill Atkinson said his institution was down $1.5 million since July 1 because of NCTracks. He worried that his billers would have to resubmit all of those claims by hand.
In an email to North Carolina Health News, DHHS communications chief Ricky Diaz said, “I did some digging and it seems that WakeMed was using the wrong number in the system, which is why they were behind. Our folks continue to work closely with them to teach them how to use the system.”
“We recognize that some providers are experiencing challenges with the transition,” Diaz said.
But DHHS is also experiencing challenges in the transition.
According to department statistics, 1.5 million professional claims were made during the first three weeks of August. Only 36 percent of those claims were approved; the departmental target was 65 percent. The department also missed other internal goals for the system.
“DHHS and its vendor, CSC, continue to address technical glitches and providers’ issues with the new claims system,” Diaz wrote. “Teams at DHHS are proactively calling those providers who are having the most difficulty with taxonomy and walking them through the steps necessary to successfully process claims and ultimately get paid.”
But that’s not the way providers are telling the story.
Amy Slattery, a medical biller in the office of Statesville obstetrician/gynecologist Michael Kepley, said she was ready to drive the two hours to Raleigh and sit in CSC’s lobby if that’s what it takes to get attention from the computer company.
She was one of the providers who sat through two days of training in Raleigh in June to prepare for the transition, and thought she would be fine.
“Our issue is that we’re having trouble getting responses,” Slattery said this week.
“If you call CSC, the hold time is over an hour, so I stopped calling them,” she said. “I’d logged several cases with NCTracks, and then waited weeks for a response.
“So I called the governor’s office. Within two hours, I had a representative from NCTracks call me, but he was not helpful … and I’ve not heard from him since.”
Slattery called the governor’s office again, and got a quick response from CSC.
“Then a representative from NCTracks called, and she was supposed to be our liaison. She was helping me with some of the smaller issues that we were having. That was during August, and we got some payments.”
It turned out that the practice had two provider identification numbers, and only bills filed on one number were making it through the system. So Slattery started submitting bills through that number and attempting to resolve the problems with the other number.
In order to submit bills under the correct number, Slattery was told she would have to go through another two-hour training. She’s been trying to register for the training for the past month without success.
“Never once have I seen a mess as big as this,” she said. “We were ready to go live with an electronic health-record system, but we’ve had to put every single aspect of our practice on hold.
“We can’t put in any more time or attention into anything else right now.”