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New Medicaid computer system doesn't end errors

New Hampshire Sunday News

July 20. 2013 9:28PM

Four months after the controversial $90 million Medicaid computer system finally began operating, some providers say they aren't getting paid properly, while another said her office was being paid 10 times the expected amount on some claims.

The Medicaid Management Information System has been frequently delayed since being contracted in 2005 to a firm now owned by Xerox.

It is causing ongoing frustration, with no end in sight, according to Bruce Burns, Concord Hospital's chief financial officer.

"We've got a $5 million backlog in Medicaid payments," Burns said.

Some of the confusion involved simple coding problems and billing rules that should have been caught before the system went live March 31, Burns said.

Concord Hospital isn't alone. "Anybody touched by Medicaid recipients is being impacted by this," Burns said.

It is taking far too long to get up and running, Burns said. "It was not well-managed through this process," he said.

Burns said he has tried to find out when it will be working properly. "They seem to not want to commit to a time frame to get the problems corrected," he said.

Health and Human Services Commissioner Nicholas Toumpas acknowledged there have been problems since the system went live, but they were to be expected with such a huge project.

"We have been dealing with a major systems conversion," Toumpas said. "I'm not saying everything is perfect, but it has gone remarkably smoothly. The system is stable, and I'm pleased overall with where we are."

Tina Emery, a reimbursement specialist at Seacoast Orthopedics & Sport Medicine in Somersworth, said Medicaid paid $500 for one claim that she would have expected to receive only $50. Another was paid at $300 when she expected $50.

When she calls the state about the problems, they don't know the reason, Emery said. She is then forced to fill out more forms.

The orthopedic surgery practice has 10 doctors and six physician assistants. Emery suspects the $500 payment for a surgical assistant was paid out as if it were a surgeon by mistake.

She has also received a denial for an assistant surgeon that didn't make sense, especially since Medicaid rules haven't changed in the meantime.

"In my mind, it should have been paid," Emery said. "When I called to ask why it was denied, the girl couldn't tell me. They can't seem to answer questions. They don't know the answers."

Emery, otherwise, praised the workers on the other end of the phone as being pleasant, even if they didn't know how to fix the problems.

"They need to work out the bugs," she said.

Emery was told there is no billing manual, a guide that explains the rules and regulations and how to bill insurers."I was told the powers that be were still working on the billing manual," Emery said.

The governor and Executive Council approved a $60 million contract to upgrade the Medicaid computer system in 2005, but the cost has risen to $90 million because of changes required by the state and federal governments, according to Toumpas.

"We have not paid anything more for the core system for which we contracted," Toumpas said. "What has changed is the additional costs for modifications we wanted or the federal government mandated."

Kevin Lightfoot, vice president of communications for Xerox, said in an email: "... I did hear back from the state (our client) and I understand they will be addressing your questions regarding the New Hampshire MMIS contract."

Gov. Maggie Hassan didn't respond to a request for an interview about the MMIS computer system. Her spokesman, Marc Goldberg, sent an email stating: "Implementing the new MMIS system, an innovative program that will significantly improve coordination of health care services, is a substantial undertaking."

Goldberg said Health and Human Services could better respond when asked how the computer payment system would improve the coordination of health care services and copied the question via email to Health and Human Services spokesman Kris Nielsen.

Nielsen said there was no one in the office Friday afternoon who could answer that question, that it would be answered next week.

Goldberg's email went on to say: "Like all new systems of this scope, issues will arise that need to be worked through and addressed as quickly as possible, and we are working closely with DHHS to ensure that they are addressing issues and keeping providers informed about the implementation process."

In New Hampshire, Medicaid, a government insurance plan for some low-income people, pays about $1.1 billion in claims a year for about 130,000 recipients to 14,000 providers. Medicaid is a 50-50 split of state and federal money, Toumpas said.

Toumpas said there have been 15 payment cycles since the system went live, paying about $20 million in claims a week.

Toumpas said he hadn't heard any concerns about overpayments or duplicative payments. The system has been very stable, with little down time, he said.

But he concedes that about 40 percent of the claims have been suspended until further analysis is done.

"Over 60 percent of claims are paid or denied appropriately, and roughly 40 percent are going into suspense," Toumpas said, meaning no determination would be made on whether to pay without researching the claim.

Providers were told at the outset they could receive contingency payments to make sure their cash flow wasn't interrupted, he said.

A new call center has opened with 15 to 20 people to respond to questions, Toumpas said, adding Xerox is paying for them.

"If somebody has other issues and frustrations, the appropriate venue is to come talk with me," Toumpas said. "I encourage them to do that."

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