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New Medicaid billing system 'A nightmare,' provider says

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HIGH POINT, N.C. -

More than two months after North Carolina's Department of Health and Human Services overhauled the way it processes Medicaid claims, major problems persist in how the system pays providers for those claims.

Laura Williard, Director of Reimbursement for High Point-based medical equipment company Advanced Home Care, calls the system 'A nightmare.'

"It's been a nightmare for the patients.  It's been a nightmare for the providers," Williard said.  "It's been a nightmare for all of the different providers that service Medicaid."

The system went online July 1.  It was designed to bring billing and payments into the 21st century, but it now requires providers enter patient information, like names, ages and medical history, manually.  Williard says software used to be able to handle that automatically.  A claims process that used to take no more than two weeks, is now stretching past two months in some cases.  There's also ongoing confusion about how to use the system.

Kimberly Lynn with Carolina Apothecary of Reidsville says DHHS wasn't prepared at launch and still isn't prepared.

"The trainers that were doing the training, some of them were only employed a week, so their training was not adequate for what we needed," Lynn said.  "They didn't know the answers to our questions."

She says those problems have now led to a backlog of claims.  Advanced Home Care alone tells WNCN they have hundreds of claims, filed at the beginning of July, for which they still have not received payment from Medicaid.  Advanced Home Care and Carolina Apothecary both report their revenues are down more than 20 percent since July, waiting on payment from the state.

That backlog also means providers are forced to choose between having patients wait for pre-authorization from Medicaid, or pay for the service and hope it's actually covered.

"We are trying to take care of the patients and the population so they don't go without the care they need," Williard said, "but there are some services you cannot provide, such as power wheel chairs which are very expensive."

A larger business like Advanced Home Care can absorb some of those costs, but Williard says some smaller businesses like family doctor's offices and pediatricians are worried they could go out of business.

"The biggest issue I see is it's an access to care for patients.  And it's only going to become even bigger."

Williard sits on the board of the North Carolina Association of Medical Equipment Services.  She says NCAMES has reached out to DHHS to help smooth out the system, but she says they haven't received a response.

WNCN attempted to contact DHHS for comment multiple times for this story, but as of Friday night, we did not receive a response.

Derick Waller

Derick is a reporter for WNCN covering crime, education, politics and just about everything in between. He has a knack for adapting to any story and consistently delivers information quickly across multiple platforms. More>>

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