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Lawmakers want quicker fix to NC Medicaid billing

Gary d. Robertson, Associated Press

RALEIGH, N.C. (AP) -- North Carolina state lawmakers and medical workers on Tuesday demanded quicker resolution of problems within the state's new Medicaid billing system as complaints mount about overdue claims payments and unhelpful call center workers.

"As a provider, we just want the issues fixed," Jennifer Keeling, an administrator at Port City Neurosurgery & Spine in Wilmington, told two General Assembly oversight committees after registering her complaint at a tense 4½-hour public hearing.

Department of Health and Human Services officials and the contractor that built the NCTracks program, which was turned on July 1, told House and Senate members they were making good progress in helping medical providers navigate the system. They said NCTracks was largely doing what it's supposed to do — taking claims and paying tens of thousands of hospitals, doctors and pharmacists that help treat 1.7 million Medicaid patients statewide.

But lawmakers first heard from several medical practice administrators who say delays are forcing some to get loans or stop seeing new Medicaid patients until they're reimbursed. Administrators of small medical practices said they were waiting on hundreds of thousands of dollars of pending claims.

"We felt like we did everything we could possibly do to get ready for NCTracks," said Sandra Williams, chief financial officer for Cape Fear Valley Health System in Fayetteville.

Williams said the system has seen a $10 million decline in cash flow because of denied or delayed claims related to NCTracks, and the hospital system's claims for chemotherapy drugs all have been denied.

"NC Tracks has made billing go from complex to borderline impossible," she said.

Susan Fountain, who works at a radiology practice in Jacksonville, said customer service representatives at the call center run by vendor Computer Sciences Corp. don't know how to solve her problems, she said.

CSC Vice President Mike Gaffney said call center training has improved, and waiting times that exceeded an hour early on have fallen to less than 30 seconds on average, he said.

Still, "we acknowledge the challenges that CSC and the state are working through," Gaffney said.

When DHHS chief information officer Joe Cooper said it would be three to six months before the remaining defects in the computer program will be resolved, one key legislator said a vague timeframe wasn't good enough.

"Saying three to six months is just not acceptable because the users can't go on doing this," said Sen. Jeff Tarte, R-Mecklenburg, who has built similar health care billing systems in the private sector.

Cooper, a longtime IT executive brought in by DHHS Secretary Dr. Aldona Wos, said more detailed information would be available. While Cooper said system data show the program moving in the right direction, the nature of a billing system means adjustments will have to be made for years to come.

Senate Minority Leader Martin Nesbitt, D-Buncombe, was incredulous when Cooper told him that he expected "virtually all providers to be successfully submitting claims" by the end of November. Providers who have been filing claims correctly for three months are still getting denied claims, Nesbitt responded.

"The focus needs to be we're off track and it has to work — period," said Rep. Susan Martin, R-Wilson, adding "I just am not confident that I hear the sense of urgency."

NCTracks replaced a billing system originally built in the late 1970s. The project has been marked by cost overruns, a stinging audit and a canceled contract with another provider before CSC took it over in 2008. CSC is getting paid $484 million to build and operate the system. Most of the price tag is being paid by the federal government.

"This is an enormously complicated system and it is our obligation to make sure that every single provider in this state is paid appropriately for the services that they are rendering to the citizens of our state," said Wos, who arrived with Gov. Pat McCrory's administration in January. "This takes time, it takes patience."

CSC brought a team of NCTracks experts Tuesday to the Legislative Office Building where the oversight committee met to help medical providers who attended with lingering problems.

Legislators seemed more pleased with a progress report of the new NC FAST program, designed as a one-stop system to enroll residents for government assistance programs such as Medicaid, welfare and food stamps.

Applications to begin or continue food stamps got delayed in mid-July a software update went out statewide, leading county social service offices to seek help for poor families through local food banks in the interim.

Today, nearly all 100 counties are processing food stamp applications at the normal rate, compared to 64 counties Aug. 15, said state Division of Social Services director Wayne Black.

"Getting the issues addressed in this area have been a lot more efficient and a lot more timely," said Sen. Earline Parmon, D-Forsyth, a vocal critic of the food stamp delays.