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When the state rolled out new software to track Medicaid treatment and payments, some physician practices went months without getting reimbursed for their work.
By Jennifer Ferris
To her pediatric patients, Beverly Edwards is a celebrity. But outside of her humble eastern North Carolina practice, the short-statured, tie dye-wearing doc has spent decades in happy obscurity. An October North Carolina Health News profile shot her into the spotlight when it revealed her practice was dying without Medicaid payments from the state.
Since that day, Edwards said, her life has been one surprise after another.
As of October, Edwards’ practice was suffering financially, with Edwards having cashed in her entire retirement savings to keep it afloat. With 80 percent of her patients receiving Medicaid, her office had incurred a series of devastating blows when the state of North Carolina failed to pay for services rendered.
“I told my staff that I wasn’t sure I’d be able to keep paying them,” Edwards said at the time.
But after the article ran, things began to look up.
Just a week later, Edwards found a small, pastel envelope mixed in with her mail. A family practice in Detroit had taken up a collection and sent a check for $599 to help with Ahoskie Pediatrics’ bills.
“I was trying to send it back but the secretary said, ‘They really mean for you to have it,’” Edwards said. “They just wanted me to keep doing my work. So I kept it. I’m sure it paid my salary that week.”
Three days later, Edwards received two carloads of visitors from Raleigh. The state Department of Health and Human Services had instructed two departments to make the two-hour drive to sort out Ahoskie Pediatrics’ financial woes.
“That article gave us exposure,” Edwards said. “I think the state read it, and they were like, ‘We are going to help you; we aren’t going to let this happen to you.’”
The first DHHS group was tasked with ensuring Edwards’ electronic health records system interfaced correctly with the state’s new Medicaid management software. The other’s job was to make sure the practice was billing the state correctly.
“They should have carpooled,” Edwards laughed. “Neither knew the other one was coming, but both were sent by the state powers-that-be. I was in awe.”
The DHHS employees confirmed the practice’s billing and software were working correctly, but no one was able to give her the money owed for patients she had seen up to two years prior. They told her she’d have to wait for another “sweep,” a departmental reconciliation that sends bulk payments to Medicaid providers.
In order to keep paying her staff, Edwards began to cut corners: She stopped paying for her EHR system, a $3,000 expense for software that didn’t meet her needs. She switched to paper charts.
She began to cut corners at home as well, eyeing a growing pile of past-due notices from the IRS and state Department of Revenue. When she had liquidated her retirement to keep Ahoskie Pediatrics’ lights on, she had failed to withhold the correct amount of taxes.
But then on an otherwise normal day in early January, Edwards received an electronic notice that $97,000 had been deposited into her business accounts. For the first time in more than three years, the state was up to date on all it owed the practice.
“Three months’ response time may seem long to someone else,” Edwards said. “But I have no doubt that was a direct result of them reading that article in October. I have no idea how long we would have been waiting otherwise.”