Category Archives: Timely Payments

If Men Are From Mars and Women Are From Venus, Then DHHS Is From Dune!

Without question, men and women see things differently.  We process things differently.  Which, of course, is why John Gray, Ph.D’s book “Men Are From Mars, Women Are From Venus” was such a huge success.  Men and women are so different that we can see (or read) the same thing and have two completely different ideas about what happened.

An example of the difference in male and female perception is how men and women view their bodies.  Men, generally, think of themselves as much better looking than they acually are in reality…

Whereas women, generally, think they are fatter or uglier than they are…

Then here comes DHHS…

Yesterday (Tuesday) at the  Joint Legislative Oversight Committee on Health and Human Services meeting, Chief Information Officer Joe Cooper said the state staffers overseeing the NCTracks system should be “congratulated on seeing this project through a successful launch.”

Congratulated??

For seeing NCTracks through a SUCCESSFUL launch??

Men may be from Mars.  Women may be from Venus.  But DHHS is from Dune and just as fictional.

The Assassination of Caesar, the Utter Ineptness of NCTracks, and Ignored Warnings

“If we do not learn from history, we are doomed to repeat it.”  George Santayana.

In William Shakespeare’s “Julius Caesar,” Caesar is warned to “Beware the Ides of March.”  See Act 1, Scene 2.  The “ides” of March is the fifteenth.  Back when Caesar established the Julian calendar, he also instituted the “ides” of a month.  Months have different “ides.”  The ides of January, for example, is the thirteenth; the ides of March, May, July and October is the fifteenth.

Caesar:
Who is it in the press that calls on me?
I hear a tongue shriller than all the music
Cry “Caesar!” Speak, Caesar is turn’d to hear.
 
Soothsayer:
Beware the ides of March.
 
Caesar:
What man is that?
 
Brutus:
A soothsayer bids you beware the ides of March

Not really sure what the point of the “ides” was, but, regardless, in 44 B.C., March 15th was the “ides” of March.

When Caesar was warned to “Beware the Ides of March,” Caesar would have known that the soothsayer was warning him about March 15th…a date certain.

Similarly, the Department of Health and Human Services (DHHS) was warned that NCTracks was not ready for its July 1, 2013, “go live”date.  Who was the soothsayer? The Office of State Auditor…Beth Wood.

In May 2013, prior to NCTracks going live, State Auditor Beth Wood published a Performance Audit that found hundreds of untested issues.  The audit warned DHHS that NCTracks was not ready to go live.  The May 2013 Performance Audit may as well have said, “DHHS, beware the first of July!”

Late in the day on March 15, 44 B.C., Caesar walked to the Theatre of Pompey, where he would be assassinated by more than 60 conspirators led by Brutus, his close ally…”Et tu, Brutus?” (Meaning…how could you, my closest friend, conspire against me?)

On his way to the theatre, Caesar sees the same soothsayer who had warned him of the ides of March.  Caesar joked, “The ides of March have come,” meaning to say that the prophecy had not been fulfilled, to which the seer replied “Aye, Caesar; but not gone.”  See Plutarch’s “Parallel Lives.”

I can only imagine the chill that ran down Caesar’s back when the soothsayer warned that the day was not over yet.

Yet, Caesar still walked to the theatre…despite the warning….

Despite the warnings in the May 2013, Performance Audit, DHHS still went live  on July 1, 2013.

Since going live, NCTracks has run into a large number of system defects. Providers in NC have been in uproar.  From not getting paid, to getting paid the wrong amount, to Medicaid/Medicare crossover issues, to taxonomy issues…the failures and defects of NCTracks have been felt by all Medicaid providers, despite the speciality.

About a month ago, NC General Assembly began demanding answers of DHHS and Computer Sciences Corporation (CSC), the entity that created NCTracks based on a $484 million contract.  On October 8, 2013, DHHS and CSC appeared before the Joint Legislative Oversight Committees on Health and Human Services and Information Technology to answer questions about NCTracks issues.

Remember, Sec. Aldona Wos stated, during the committee meeting, that DHHS was not warned by an entity of the risk to go live with NCTracks.  To which, Auditor Wood stated, “For the secretary to say there was no independent or anybody else that had given them a look at their risk readiness for going live on July 1 was not a true statement to the committee, and we felt like that the committee needed to know that information.”

State Auditor Wood is the soothsayer.  “Beware the first of July!”

Just as the soothsayer did for Caesar, prior to NCTracks going live, Wood warned DHHS that NCTracks was not ready.  Just like Caesar, DHHS did not stop NCTracks from going live (he went to the theatre anyway).  Just like Caesar’s death, the failure and ineptness of NCTracks was forewarned and could have been prevented.  Both DHHS and Caesar ignored the warnings.

So how bad is NCTracks?

According to the December 2013 Performance Audit, “the NCTracks system has encountered more than 3,200 defects.”

Here are the Audit’s findings:

FINDING #1: THE DEPARTMENT HAS AN INADEQUATE FRAMEWORK FOR THE TIMELY RESOLUTION OF NCTRACKS DEFECTS

Since going live, the NCTracks system has encountered more than 3,200 defects. More than 600 defects remain unresolved at the time of the audit.

FINDING #2: THE DEPARTMENT LACKS A COMPREHENSIVE MASTER ACTION PLAN TO ADDRESS NCTRACKS ISSUES

The Department does not have a comprehensive and cohesive master action plan to direct the remediation of technical and operational NCTracks issues.

FINDING #3: NCTRACKS GOVERNANCE CHANGES PRESENT BUDGETARY AND SYSTEM CAPABILITY RISKS TO THE STATE

Since July 1, 2013, there have been major updates to the approach the Department will take to implement required capabilities. These changes present budgetary and system functionality risks to the State.

FINDING #4: STATE GOVERNMENTS ‘REVOLVING DOOR’ CREATES A PERCEPTION OF BIAS OR CONFLICT OF INTEREST

A former DHHS employee who served for more than four years as the NCTracks Senior Program Manager and Associate Program Director now works for the NCTracks vendor, CSC, as the NCTracks Executive Account Director.

From Finding #4, it appears that CSC, like Brutus, is working hand in hand with DHHS.

If we do not learn from history, we are doomed to repeat it.  “Beware the ides of March!”

“Et tu, Brutus?”

Former DHHS staffer takes jobs with Medicaid contractor

I cannot take credit for this blog.  I cut and pasted the test from WRAL.  But…WOW!!!!

Raleigh, N.C. — A state employee who helped oversee the construction and rollout of the NCTracks Medicaid billing system now works for Computer Sciences Corp., the contractor responsible for the troubled project. Paul Guthery was an IT manager at the Department of Health and Human Services, where he had worked since January 2010. At a hearing Wednesday, State Auditor Beth Wood described him as the agency’s “point person” for CSC, responsible for certifying NCTracks’ testing process. At least one good-government watchdog says his jump from supervising the company to working for it raises the appearance of a potential conflict of interest, one that the state should try to avoid in the future.

According to public records, Guthery began working for the state on Jan. 1, 2010. His last salary was $126,500 per year. He stopped working for the state Aug. 27 and soon after began working for CSC as an executive account executive.  Doctors, hospitals and others who render care for patients covered by Medicaid, the state-federal health insurance program for the poor and disabled, must use the CSC-built NCTracks system to get paid for those services. The system went live July 1 and soon after become the focus of controversy, with providers saying it was nearly impossible to submit claims and that payments were delayed by months. The delays threatened to drive some providers out of business and complicated care for thousands of patients.

Since then, the state and CSC have struggled to right the program. It was in late August, as providers bombarded lawmakers and the governor’s office with complaints about the system, that Guthery made the jump to the private sector.
Guthery declined via email to speak with WRAL News, deferring to his company’s corporate communications department. Michelle Sicola Herd, a spokeswoman for CSC, declined a request for an interview and was not willing to speak on the record about the circumstances of Guthery’s hiring.

Officials with DHHS downplayed Guthery’s part in the rollout of NCTracks, saying Thursday that he never occupied a position in which he would give the final word on the program going live. “One of the key things is that Paul was one of many people involved in this project, a very large project going on for a very long period of time,” said Ricky Diaz, a spkesman for the department.  Diaz emphasized that an outside testing group reviewed the stability of the NCTracks system before state officials turned it on July 1.

But Wood blasted the role of that third-party overseer, saying the company hired for independent verification and validation of system testing had not actually conducted any independent verification. Rather, they merely collected information from DHHS and CSC and summarized it in a report.

During a hearing Wednesday, Sen. Jeff Tarte, R-Mecklenburg, asked Wood who was responsible for signing off on reports that system testing had been completed and was successful.

“The agency,” Wood answered, adding, “The point person that was at the agency is now working for CSC.”  That person was Guthery. 

Diaz said state personnel laws prevent him from talking about what, if any, steps were taken to try to keep Guthery as an employee. But he emphasized that the state had taken strides to get the system on track, pointing out that it has been under construction for more than 10 years. 

“There have no doubt been challenges. This is a very large transition for the state of North Carolina,” he said. “The NCTracks project has, to date, paid $3.8 billion to North Carolina health care providers, as well as processing more than 78 million claims.”  With regard to Guthery, Diaz said state law does not currently prohibit employees who work with a contractor from taking a job with that contractor. By contrast, had Guthery taken a job as a lobbyist, he would have needed to wait six months before working with the legislature or his old employer. No such cooling-off period applies to employees in other lines of work. 

Jane Pinsky, with the North Carolina Coalition for Lobbying and Government Reform, says lawmakers should consider changing that.  “If I’m a skeptical, cynical citizen, the question is, did he (Guthery) give them a pass and then they gave him a job?” Pinsky said.  Earlier this year, another high-ranking DHHS staffer left for a private-sector job. Former state Medicaid director Carol Steckel was recruited to overhaul North Carolina’s system but left abruptly for a position with Wellpoint, a managed-care company based in Florida.

Pinsky pointed out that Wellpoint could end up bidding to run some or all of North Carolina’s Medicaid services under the McCrory administration’s planned reforms.
“In state government, and in DHHS, it is not unprecedented for employees to go work for vendors,” Diaz said. 

Asked if he thought the Guthery situation could be viewed as a conflict of interest, Diaz said DHHS was being “very transparent” with regard to the situation. Asked if the agency would put any policy changes in place, Diaz referred to DHHS Secretary Aldona Wos’ efforts to improve contracting practices more broadly.  “I think what you’ve seen is this secretary has placed a heavy emphasis on contract oversight and compliance,” he said.  But Pinsky says the problem could be addressed in other ways.  “One thing you can do is tell the contractor that, as a condition of the contract, they can’t hire anybody” in the agency, she said. She also suggested the possibility of a non-compete clause for employees hired to administer contracts.

In the meantime, she says, lawmakers should consider instituting a cooling-off period for high-level staffers.  “Anybody who oversees a contract or supervises an industry shouldn’t be able to go to work for them the next day,” she said. “Does that affect any decisions they’re going to make in how they administer the contract?”

Lawmakers Demand Accountability as to NCTracks Debacle (Finally) and the Action of Nonaction

Yesterday (11/20/13), State Auditor Beth Wood appeared before the Joint Program Evaluation Oversight Committee meeting.  Lawmakers and Wood criticized NCTracks, its rollout, and the lack of accountability on the part of the administration. Sen. Stan Bingham, R-Davidson, even asked whether criminal charges could be filed against whomever was in charge of the NCTracks rollout. 

Criminal charges!!

There is little disagreement that the rollout of NCTracks has been a complete CATASTROPHE.  NCTracks went live July 1, 2013, and the past 143 days have been nothing short of a hair-pulling-out, feet-stomping, spit-wielding debacle for most providers. So lawmakers, as the health care providers have been asking for the past 143 days, ask, “Who is to blame?”

Who is to blame?

  • The Department of Health and Human Services (DHHS)?
  • Computer Sciences Corporation (CSC) (the company who designed NCTracks)?
  • Independent Verification and Validation (IV&V) Contractor? (the third-party contractor hired for independent verification and validation of NCTracks)?
  • Governor Pat McCrory?
  • Secretary Aldona Wos?

No one in the administration is stepping up to accept accountability.  The vendors are not accepting responsibility.  It is as if the Department of Health and Human Services (DHHS) is just standing there…watching the debacle…doing nothing.  I am reminded of Dr. T.J. Eckleburg.  Anyone remember who Dr. Eckleburg is?

Dr. T.J. Eckleburg’s spectacled eyes are a powerful symbol in The Great Gatsby, one of my favorite novels of all time, written by F. Scott Fitzgerald.

Dr TJ Eckleburg

Originally, the billboard was erected to promote Dr. Eckleburg’s optometry practice.  The eyes are supposed to symbolize commercialism and the greed of America, but the billboard is neglected and the eyes remain throughout the story to symbolize God watching over Nick Carraway and the other characters.  The eyes seem to be an all-knowing and all-powerful figure over the characters. The eyes frown down on the characters and judge their actions.

Wilson equates T.J.’s eyes to the eyes of God. He recounts to Michaelis what he says to Myrtle after discovering his affair, “‘and I said “God knows what you’ve been doing, everything you’ve been doing. You may fool me, but you can’t fool God!”” However, Michaelis tries to point out to him that “It’s just a billboard.”

Maybe it is not just a billboard. 

Throughout The Great Gatsby, Eckleburg’s eyes watch.  Yet, in the novel, God, symbolized by Dr. T.J. Eckleburg’s spectacles, seems to have abandoned America, leaving only Dr. T.J. Eckleburg behind to stare down with his empty eyes.  Dr. T.J. Eckleburg never moves…never speaks. Yet, Fitzgerald creates this looming, unmoving billboard and characterizes the billboard as God.  And who is more in charge than God?

Similarly, (not as to God, but as to Dr. T.J. Eckleburg), DHHS is supposed to be the all-knowing and all-powerful head of North Carolina Medicaid. 

42 C.F.R. 1396a(5) requires the State Plan to “either provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan; or provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan.”

That single state entity is DHHS.

DHHS is charged with watching over all things Medicaid.  DHHS is our Medicaid Dr. T.J. Eckleburg.

When State Auditor Wood was asked by legislators who is to blame, she answered, “The agency.” As in, DHHS.  “Accountability comes at the secretary level, those that report to the secretary, and the governor.”

If DHHS is in charge and Secretary Wos is in charge of DHHS, then (going back to Logic 101) Wos is to blame for the NCTracks debacle.  Right? 

Before jumping up and down and blaming Secretary Wos for NCTracks, remember that it was the prior administration that began the whole NCTracks idea in the first place.  Wos did not come to NC and say, “Hey, let’s change the Medicaid billing system.  There is this company CSC that will be so perfect for the job.  Let’s pay them a ton of money to revamp the entire system.”  No, Wos came to NC with NCTracks already begun.  The past administration started this little ball rolling.  Wos stepped in when the ball was huge and its inertia kept it going…or should we say Wos did not stop the rolling ball.

Does that exonerate Sec. Wos from any accountability and/or blame for the current state of mess Medicaid is now in due to NCTracks? Absolutely not.  It is without question that Sec. Wos is charged with managing DHHS.  It is without question that Sec. Wos has not accepted the accountability of the NCTracks debacle.  Shoot, she hasn’t even admitted there is a problem!! Isn’t admitting there is a problem the first step?

Someone at DHHS made a fatal flaw in implementing NCTracks.  Someone told HP Enterprises to take a hike without ensuring that NCTracks would work.  That is like walking a tight rope with no net!  And that fatal decision is on this administration.

Like Dr. T.J. Eckleburg, DHHS is watching over Medicaid.  And like Dr. T.J. Eckleburg, DHHS is unmoving and silent.

DHHS cannot be a billboard.  Nonaction is not an option.

Senator Bingham asked whether we could fire anybody (whomever was in cgarge of the debacle).  To which, Wood stated, in her normal, no-nonsense manner, “I don’t have a problem firing anybody.”

One News and Observor editorial wrote, “What Wos should have told lawmakers wasn’t that she’s pressing DHHS staff and its computer vendor to pay people who are owed. She should have said, “We thought we were being frugal and instead we were reckless and it has cost everyone a great deal. I take responsibility. I apologize. And I’m determined to keep learning from my mistakes to fulfill the mission of my department.”  Instead, she told the committee, “I assure you that where necessary, I will hold people accountable.”  Excepting herself, of course.”

Right now DHHS is just a billboard.

In fact, maybe the most important nonactions to note are what Sec. Wos is NOT doing.  She has has NOT blamed CSC.  She has NOT condemned CSC.  She has NOT had heads rolling at CSC.   Sec. Wos has NOT publicly spoken disparagingly about CSC’s implementation of NCTracks.  She has NOT terminated CSC’s contract.  To my knowledge, she has NOT asked for help from HP Enterprises.  Right now, DHHS is nothing more than a billboard, a symbol of Medicaid, but doing nothing.

In fact, on Tuesday, DHHS representatives tried to tell the Joint Program Evaluation Oversight Committee that NCTracks was improving and its “trajectory is good.”  Doing nothing…just watching…

In The Great Gatsby, Dr. T.J. Eckleburg’s eyes never change.  They continue to watch.  Unlike Dr. T.J. Eckleburg, Sec. Wos can move.  She needs to move. 

Yet, whereas Wood said that she doesn’t have a problem firing anybody, Wos stated on Tuesday “that, where necessary, I will hold people accountable.” 

Where necessary?? 

Aren’t we to “where necessary” yet?  143 days after the catastrophic implementation of NCTracks and the mess is not fixed….don’t you think it is necessary to hold someone accountable??

Oh, and by the way, during these past 143 days since NCTracks’ implementation, who is getting harmed?  The doctors, the dentists, the in-home health care providers who are not receiving proper Medicaid reimbursements.  And then who suffers? The Medicaid recipients because providers stop accepting Medicaid.  In a Medicaid system that already discourages providers from accepting Medicaid, NCTracks is certainly not helping.  Counting business damages, loss of clinical time, and unpaid claims, can you imagine the invoice that the harmed providers should serve on DHHS??   Maybe the invoice sent to DHHS should give DHHS 15 days to request a reconsideration review.

One thing is for certain, DHHS (whether or not through Wos) must stop merely being a symbol of Medicaid, a billboard, and start acting… and be accountable.

Because after 143 days of this hair-pulling-out, feet-stomping, spit-wielding debacle for most providers, there aren’t many more hairs, stomps, or spit.

DHHS Still Claims NCTracks on Track?? CSC Doing Its Best?

Today  the Joint Legislative Oversight Committee on Health and Human Services met at noon. Mr. Joe Cooper, DHHS’ Chief Information Officer, spoke on behalf of DHHS.  He began by explaining that NCTracks is not NC Fast, which I believe we already knew.

Most interestingly, it was stated that DHHS has assessed approximately a quarter of a million dollars in penalties against CSC since NCTracks going live.  These assessments are paid to the state.  To which I ask, “Why does CSC pay penalties to the state? Why not pay the people actually damaged by CSC’s ineptness..the unpaid providers?”  It makes no sense that, while providers are not getting paid, CSC pays the state.  That’s like a robber paying restitution to the insurance company that never covered the losses of the victim.

Another interesting comment was when asked exactly how much has been spent on NCTracks, Mr. Cooper deferred to DHHS’ CFO, Rod Davis who answered that he does not have that information.  To which Senator Tarte stated, “That doesn’t make me feel comfortable.”

Mr. Cooper described CSC’s monumental effort to try to get providers paid.  According to Mr. Cooper the “backlog” will be nonexistent by the end of the year.  But when asked, “What is the number of remaining backlogs?” Mr. Cooper answered, “Senator, I don’t have that number.  I can get it to you.” 

When asked a follow-up question about whether the number of backlogs was similar to a previous number of approximately 43,000, Mr. Cooper noted that there are two types of backlogs.  One backlog addresses prior authorizations, and, according to Mr. Cooper there is no more backlog as to prior authorizations.  NCTracks is absolutely current. The non-current backlog is regarding returning calls and responding to emails.

Providers, Is it true? Is NCTracks current as to prior authorizations?

Mr. Cooper further stated that calls to the Call Center are now answered within seconds. Last week CSC implemented a new process for answering phone calls that when providers call the Call Center, CSC estimates when it will call back the providers in order to stop the providers from staying on the phone too long.  That’s great, but getting an estimated time for a callback doesn’t really resolve the problem, right?

Mr. Cooper also showed a graph depicting total Medicaid claims payments from State fiscal year 2012 through October 2012 (the graph on the left) and payments from State fiscal year 2013 through October 2013. 

NCTracks Payouts

Obviously the point of this graph is to demonstrate that CSC is approximately right on track with what HP Enterprises paid last year.  And, I agree, when looking at this graph, it appears that both CSC and HP paid out similar amounts for the different years.  But the graph does not explain whether the volume of claims increased from 2012 to 2013.  One would think that the number of claims increased in 2013, as our population grew.  So is the comparability of the graph deceiving?

Senator Nesbitt pointed out that another graph, the graph depicting claims adjudication, does not appear to demonstrate positive progress.  He said, “It doesn’t look like we are fixing the problem.  We are generating more and more bills that aren’t being paid.”

Here is the chart Senator Nesbitt was talking about:

Chart

Senator Nesbitt pointed out that, according to the chart, it looks like claim adjudication is declining.  He sais that he heard someone mention that 70% is the goal, but he doesn’t think that 70% is a good goal.  Why not 100%?

After Senator Nesbitt made his comments, the meeting adjourned until 2:00.  If you want to listen to the committee meeting, click on: http://ncleg.net/Audio/Audio.html.  and select “Appropriations Committee Room (Rm 643).”

DHHS Takes 35 Years to Become Federally Compliant With Medicare/Medicaid Crossover Issues

It is without question that the implementation of NCTracks has been a complete debacle.  NCTracks is the new computer system that is processing Medicaid claims for all health care providers who accept Medicaid in North Carolina.  NCTracks went live July 1, 2013.

Immediately upon going “live,” providers received error messages.  Providers were not timely paid.  If the provider was paid, the reimbursement amount was incorrect.  Depending on the type  of provider you are, your issues varied from other types of providers.  But all types of providers encountered adverse issues.

I still do not understand, even today, why the current administration did not stand up (figuratively and publicly) against Computer Sciences Corporation (CSC) the company contracted to create NCTracks and say, “North Carolina, CSC has created this debacle.  We didn’t hire CSC.  The past administration did.  We will try to fix this debacle now…” That would have been the best public relations move, in my mind.  However, instead, the Department of Health and Human Services (DHHS) stood by CSC and stated publicly how wonderful NCTracks was doing….”NCTracks is on track!”

Oh, well, suum cuique.  Or…to each his own.

One of the biggest problems for providers with NCTracks is the Medicare/Medicaid crossover issue.

What is the Medicare/Medicaid crossover issue?

DHHS explains the crossover issue in the November 2013 Medicaid Bulletin as the “Medicaid Allowable minus Medicare Paid Amount equals the Net Medicaid Allowable. Next, the Net Medicaid Allowable is compared to the Medicare Coinsurance Amount and the lesser of the two is the amount payable by Medicaid.”

DMA also offers the following chart as clarification

   Example No. 1  Example No. 2
Total Billed Charges

159.00

159.00

Medicare Allowed Amount

100.34

80.26

Medicare Paid Amount

79.95

64.21

Medicare Contractual Adjustment

(58.66)

(78.74)

Medicare Coinsurance Amount

20.39

16.05

 
Medicaid Allowable

84.29

85.20

Medicare Paid Amount

(79.95)

(64.21)

Net Medicaid Allowable

4.34

20.99

 
Lesser of Medicare Coinsurance and Net Medicaid Allowable Amount

4.34

16.05

DHHS goes on to say that even though the crossover claims should have been paid according to the above logic, the payments to providers for crossover claims on the NCTracks system versus the HP system may be different, as in, you may be getting paid less on the NCTracks system.

Why? We had the HP system for 35 years.

Well, according to DHHS, because the HP system “lacked the capability to perform such calculations on a claim specific basis. Instead, the prior Medicaid claims system included a “work around” that estimated the amount payable. In some cases, the “work around” paid more than the amount payable in accordance with State law and the North Carolina State Plan approved by CMS.”

Hold on….Hit the brakes!!!

Is DHHS telling us that NC was not federally compliant with Medicare/Medicaid crossover claims for 35 years???!!!!???

So, how much does NC owe to the federal government for overpaid crossover claims over a 35-year period?? And will it be extrapolated?  Maybe PCG can audit NC.

This boggles my mind. 

Here is the other fact that boggles my mind:

According to DHHS, “on October 7, 2013, NCTracks implemented system logic to more precisely pay Medicare crossover claims in accordance with State law and the North Carolina State Plan approved by the Centers for Medicare and Medicaid Services (CMS) on a claim specific basis. The amount of payment is the difference in the amount paid by Medicare and the Medicaid Allowable amount up to the actual amount of the Medicare coinsurance, deductible or both.”

On…October….7th???

98 days after NCTracks went live???

Why in the world would this Medicare crossover issue NOT be implemented PRIOR TO going live?  The Medicare crossover issue just doesn’t seem to be a “Eh, whatever…Let’s take a gamble” issue.

So I propose a toast to DHHS.  Well done.  Well done on becoming federally compliant as to the Medicare/Medicaid crossover claims (if, in fact ,we are) 35 years later.  And well done, to implementing a NCTracks implemented system to “more precisely pay Medicare crossover issues” 98 days after NCTracks went live.

To timeliness!  Here!  Here!! (the clinking of glasses).

Maybe…just maybe….in 200+ years, NC may fix the broken Medicaid system…

Government Shutdown: No Medicaid Funds Available in D.C., So Why Am I Still Getting My Mail!

Hey, have you heard??? Our federal government has shut down. So why am I still getting mail???

Unless you have lived under a rock for the past couple weeks, you are aware that our esteemed federal government has shut down.  At least…partially.  I keep getting mail.  Social security is still getting paid.  But don’t you dare try to visit a national monument…those are off-limits!! Really? Who decided what gets shut down and what stays open?  How is it that I still get my cable bill, but cannot visit Yellowstone National Park??

How is all this tomfoolery affecting Medicaid?  Minimally, in most areas, but Medicaid fundings HAS STOPPED in Washington D.C.

Why stop Medicaid funding in D.C. when the federal air traffic controllers are still working.  The State Department continues processing foreign applications for visas and U.S. applications for passports.  The federal courts are open.  The National Weather Service is still working.  Student loans are still getting paid. The Veterans’ hospitals are all up and running.  The military is still working.  I guess, Obama and White House staff are still working. (Although Obama could be on the golf course).  The Post Office is delivering mail.

Yet, here are some random federal actions and agencies that are actually stopped/closed:  Food safety inspections are suspended; U.S. food inspections abroad have also been stopped.  Auto recalls and investigations of safety defects are stopped.  Taxpayers, who filed for an extension in the spring, still have to pay their taxes by today, yet the IRS is not processing tax returns (How does this make sense??). The Consumer Product Safety Commission (CSPC) is not working.  (Great, after the CPSC starts working again, there are sure to be numerous lawsuits based on new product defects that have been placed in the market over the last 2 weeks).  The Environmental Protection Agency (EPA) has ceased to run, which means we have two weeks of allowable pollution.  Many at the Federal Bureau of Investigations (FBI) and the federal housing agency are furloughed.

How does this shutdown make any sense?? Who determined that the IRS should not process tax returns, but should accept taxes?  Who decided that safety inspections should be stopped, but passports should still be processed?

That safety inspections of food and products should halt, but students should still get federal loans.

Where is the logic?

It is as if someone said, “Shutdown the federal government!! Except not the mail, passports, and the weather service…keep those running!”

And then Medicaid in D.C…. Why did Medicaid funding stop only in D.C.??  While I still think if the mail is being delivered that D.C. providers could get Medicaid fundings, I will attempt to explain the illogical reason below:

Because D.C. is not a state.  D.C. is a local government without a state, so its budget must be authorized by U.S. Congress.  And Congress has not passed a budget.

D.C. has $2.7 billion budgeted for Medicaid, but providers are getting nothing (and, quite possibly, some recipients).  I can only imagine how this is negatively impacting health care providers in D.C. I am sure many of the providers are still rendering services unpaid.  But some, I would imagine, are closing up shop.  I know I could not last financially without a paycheck for 3 months.  I am sure many of the D.C. providers are no different.

But it still makes no sense.  Just like NC, D.C. pays for about 30% of Medicaid with the federal government reimbursing about 70%.  If NC’s federal reimbursements are still being paid, why not in D.C.?

And why am I still getting mail????

Well, my heart goes out to all the Medicaid providers and Medicaid recipients in D.C.  I hope you receive Medicaid fundings very soon.

Although, at least D.C. providers know that, at some point, the Medicaid funds will be funded; whereas in NC we still have NCTracks.

NCTracks and DHHS: The Importance of Being Proactive

My daughter came home from school a couple of weeks ago with a bad grade on a test.  I sat her down and explained the importance of being proactive.  I explained that if she knows that a test is coming up that it is her responsibility to study in advance for that test and her responsibility to inform me that the test is coming so that I can ensure that she studies enough (she is only in the 3rd grade, so I still have to check all her homework).  She understood and has been bringing home A’s ever since. 

She gets study sheets prior to a test…she just wasn’t using it.

The importance of being proactive…

To my daughter, being proactive meant the difference in a bad grade and consistent A’s.

Now here we are….NCTracks’ 3-month anniversary!

October 1, 2013, DHHS released a press release touting the “proactiveness” of DHHS dealing with NCTracks issues.  In fact, the word “proactive” is used 6 times in the one page press release.

According to the “thefreedictionary.com,” proactive is defined as: “Acting in advance to deal with an expected difficulty; anticipatory.”

How is DHHS acting proactively to deal with NCTracks problems if the “proactive” measures occur 90 days AFTER NCTracks goes live??????!!!!!

The October 2013 Medicaid Bulletin offers information pertaining to the following topics:

All Providers:

NCTracks Common Issues
Staying Current on ICD-10
NCTracks User Guides Available
Receiving Email Alerts Through NCTracks
NCTracks Contact Information
Clinical Coverage Policies

4 topics with information germane to NCTracks.  And there is quite a bit of information within each topic.

In the June 2013 Medicaid Bulletin (the month prior to NCTracks going live), this is the information DHHS provided:

NCTracks is a multi-payer system that will consolidate several claims processing platforms into a single solution for multiple divisions within the N.C. Department of Health and Human Services (DHHS), including the Division of Medical Assistance, the Division of Mental Health, Developmental Disabilities and Substance Abuse Services, the Division of Public Health, and the Office of Rural Health and Community Care.

The new NCTracks system will go live on July 1, 2013. In advance of that date, there are a number of things that providers can do to prepare for the transition, including taking advantage of upcoming training opportunities.

The June Medicaid Bulletin also provided info as to signing up for emails with NCTracks and the checkwrite schedule.  But nothing as thorough as the October Medicaid Bulletin.

Sure, you can make the argument that DHHS could not have provided more information prior to going live because DHHS had no idea what future problems there would be.  Obviously, DHHS also cannot foretell the future.

BUT….DHHS DID HAVE ADVANCE WARNING OF POSSIBLE ISSUES.

Remember the May 2013 Performance Audit conducted by the State Auditor Beth Wood?

One of the recommendations in the Performance Audit was that “[t]he Department should re-evaluate its current “Go” decision for July 1, 2013, once final Go/No-go criteria is established and documented. This assessment should incorporate the final user acceptance testing and production simulation testing results.”

Finding #5 shows that DHHS had no “go-live” criteria to even determine whether NCTracks should go live.

Finding #3 states that the assessments for NCTracks were live and put system readiness at risk.

Finding #2 states that the production simulation testing is flawed.

Finding #1 states that hundreds of critical user test cases were not conducted.

Before a test, my daughter has a study sheet to review…to make sure that she is fully prepared for the test.  Similarly, DHHS had a Performance Audit to review…to make sure DHHS and the Medicaid providers were fully prepared prior to going live.

Unlike my daughter, DHHS failed to study.

The importance of being proactive…

NCTracks: The Defective Design Affects ALL NC Medicaid Providers!!

Today I tried to think about the worst things that have ever happened in history. I came up with the Holocaust and the Civil War.  The Civil War because more Americans died in that one war than all other wars in which America has been involved combined (until the Vietnam War).  Roughly 1,264,000 American soldiers have died all America’s wars over history, in aggregate (620,000 in the Civil War and 644,000 in all other conflicts).  It was only as recently as the Vietnam War that the amount of American deaths in foreign wars eclipsed the number who died in the Civil War.  So, maybe my second horrible thing is war, in general.

Regardless, why was I trying to think of the worst things in history?

Because NCTracks has got to be one of the worst things to happen in North Carolina history to Medicaid providers.  Obviously, I am not insinuating that NCTracks is comparable to the Holocaust or wars, in general. But to the Medicaid providers in NC, NCTracks may be as awful as the Holocaust or a war, in general (to those individual providers).

NCTracks’ defectiveness has adversely affected ALL PROVIDERS.  It has hit big providers, such as hospitals.  (WakeMed recently announced a loss of 2.5 million due to NCTracks), and small providers (I receive 2-5 phone calls daily from small providers who have not received either (a) payment; or (b) correct payment). 

A while ago I wrote the blog “Why There is Not a Lawsuit Against NCTracks” (paraphrasing my own title).  Well, as humans sometimes do, I am recanting my prior opinion as to one factor.  I wrote in my prior blog that if providers sued NCTracks, then NCTracks paid the providers, that the lawsuit would no longer have merit…as in, if NCTracks actually paid providers that providers would have no damages (because damages is a criterion for a lawsuit).

I am officially recanting that statement.

People sue manufacturers every day in products liability for defective design.

What are examples of a defective design?

  • A defective nail gun that shot through a wall, paralyzing a man in another room;
  • A lock-up of a poorly designed braking system that led to the death of a mother and her four children;
  • Machines at work — such as saws, presses, packaging machines, come-along chain hoists and other tools — with defective safety features that have blinded or caused hand or arm amputations to users;
  • Retractable dog leashes that led to finger amputations;

These examples are courtesy of a law firm in Boston.

My example?

A computer system implemented to provide payments to Medicaid providers, but upon implementation, actually causes Medicaid providers to not receive Medicaid reimbursements…  Obviously, the very reason NCTracks for which NCTracks was created is defeated.

It would be like me hiring a painter to paint my house.  But, instead of painting my house, the painter eggs it.

Issues I have heard of regarding NCTracks:

1.  NCTracks fails to correctly reimburse Medicare/Medicaid crossover claims;

2.  NCTracks fails to correctly reimburse office visits, assuming that the Medicaid recipients are giving a $5 co-pay, not a $3 co-pay;

3.  NCTracks fails to reimburse for immunizations and a well-child visit;

4.  NCTracks fails to reimburse for injections and an adult office visit;

5.  NCTracks incorrectly determines that a provider’s license has expired and does not reimburse;

6.  NCTracks fails to comprehend its own taxonomy codes;

7.  NCTracks fails to recognize secondary claims;

8.  NCTracks incorrectly suspends provider numbers;

9.  NCTracks incorrectly denies claims with multiple NSTs during the same inpatient encounter;

10.  NCTracks fails to reimburse for ambulance services.

Design defect?  Probably.  Holocaust? Probably not (although I am sure it feels like it to all individual providers).  War? Probably not (although I am sure it feels like it is to all individual providers).

Regardless, the damages are not just the non-payment of Medicaid reimbursements.  Now it may be damages for a design defect…

Now THAT may be a tort!!!

CSC, the Creator of NCTracks, Pays $97.5 Million in Settlement for “False and Misleading Information” Regarding the Company’s Performance as to a Computer Records Contract

You know the magazine Cosmopolitan?  Well, back in 1999, Cosmo decided to branch out from magazines and create a Cosmo yogurt.  Never heard of it?  That’s because Cosmo pulled the yogurt off the market within 18 months of entering the market.  Cosmo yogurt was a complete flop.  But, still, Cosmo yogurt was on the market for 18 months.

Remember “New Coke?” (I’m showing my age).  But back in the late 70s and early 80s, Coca-Cola launched the “New Coke.”  It was an utter flop and consumers demanded the original Coke to return.

If it takes 18 months for NCTracks to be “pulled from the market,” a great number of our Medicaid providers will either be (1) out of business; or (2) no longer accepting Medicaid.

It is indisputable (at least if you do not work for the Department of Health and Human Services (DHHS)) that NCTracks is severely OFF-TRACK.

Providers are going out of business because they are not receiving Medicaid reimbursements.  Or the reimbursements are below the standard reimbursement rates.  There are Medicare and Medicaid crossover problems.  Not to mention providers are extremely frustrated with the amount of time they need to devote to NCTracks issues.  See September 19, 2013, article by Rose Hoban.

Why has NCTracks been such a failure?

Obviously, I do not have the answer to that haunting question.  Believe me, I have heard it all.  I’ve heard that McCrory wants NCTracks to fail because NCTracks was past Gov. Perdue’s baby.  I’ve heard that McCrory wants NCTracks to fail because then he can privatize Medicaid.  I’ve heard that Computer Science Corporation (CSC), the company that writes the computer language for NCTracks is inept.  I’ve heard that CSC begged Wos not go “live,” but Wos pushed the go “live” date.  I’ve heard that the employees at CSC have no idea what they are doing.  I’ve even heard that all the Republican governors have conspired to fo everything in their power to derail the Affordable Care Act (ACA) and this is just one example.

Most likely, none of the above is completely correct…or a small bit of everything.  Regardless, the NCTracks system is hurting our providers that accept Medicaid.  It should not be a party issue.  It is a North Carolina issue.  And, just think how popular the administration would be if they came out tomorrow and trashed the whole NCTracks system….Now that would be something!!!

With all that said, I found an interesting tidbit the other day about CSC.

September 9, 2013, CSC settled a lawsuit with its shareholders for $97.5 million.  Is this germane to the NCTracks tomfoolery that we are all enduring?  Perhaps not…but…perhaps.

Shareholders of CSC (which, BTW, is a BILLION dollar company) brought a class action lawsuit against CSC over alleged false statements about accounting and the company’s performance on a multibillion-dollar contract.  Click on “class action lawsuit” to read the Complaint.

A Memorandum filed in support of the Complaint alleged that CSC “made false or misleading statements or omitted to disclose material facts” about internal controls over financial reporting and about CSC’s performance on a $5.4 billion electronic patient records contract with the U.K.’s National Health Service.

The plaintiffs alleged that the false and misleading statements regarding the controls over financial reporting and CSC’s performance on the $5.4 billion contract caused the stock to artificially inflate then plummet when the truth came out.

After reading the Complaint, this is what I gleaned that CSC allegedly did with respect to the electronic patient records contract (sound like what CSC has here in NC?):

Under the National Health Service (NHS) Contract, CSC agreed to build a computerized medical records system and develop the necessary software to create digitized medical records for all UK residents living within the regions covered by the contract.

This is directly from the Complaint…I find it very interesting…(the non-italicized words are mine):

The core component of the NHS Contract—the software system called Lorenzo , [NCTracks] intended to enable the digital medical records system—was to be delivered by 2012 [July 1, 2013]. The significance of the NHS Contract to CSC placed the project squarely in the spotlight of Wall Street analysts. Accordingly, virtually all conference calls between the Company and investors and virtually all public announcements during the Class Period addressed the progress and status of the NHS Contract. Throughout the Class Period, Defendants repeatedly asserted that CSC was “on track” and “making progress” and that the contract remained profitable to the Company. Likewise, CSC and the Individual Defendants continuously denied media reports critical of CSC’s performance of the contract. As analyst reports throughout the Class Period demonstrate, investors believed Defendants. However, Defendants’ representations were false because they had known, at least since May 2008, that CSC could not deliver the Lorenzo system [NCTracks] as promised. The Class Period begins on August 5, 2008, the date of Defendants’ first public misstatements following May 2008. Lead Plaintiff’s investigation has revealed that, as of May 2008, CSC and the Individual Defendants knew that the NHS Contract could not be fulfilled. In early 2008, CSC’s Board of Directors dispatched an internal team of experts to the UK to review progress on the NHS Contract. The team concluded that “from a technology and operational perspective,” CSC could not perform the NHS Contract [NCTracks]. The members of the team were in agreement that CSC simply could not deliver the software necessary to perform under the contract. As such, the contract was a “loser,” and, per Generally Accepted Accounting Principles (“GAAP”), CSC should have recognized a loss on the NHS Contract in 2008. CSC and the Individual Defendants concealed these facts from the public, and have never taken a loss on the contract. In the midst of public scrutiny, the UK Government commenced an investigation through a committee of Parliament with oversight over public spending. The committee reached similar conclusions: CSC could not deliver on the NHS Contract. Indeed, the Parliamentary inquiry revealed evidence that CSC had likely known it could not deliver since 2006.

If I am reading the allegations correctly, the plaintiffs asserted that CSC promised a computer program regarding electronic patient records that CSC knew it could not deliver.

Hmmmmmmm….

As an aside, CSC’s reported revenue for fiscal year 2011 (ending April 1, 2011) was $16.04 billion, and net income attributable to CSC shareholders was $740 million. CSC common stock is listed and trades on the NYSE under the ticker symbol “CSC.”

 Companies deal with marketing/products failures every day.  Just look at Cosmo’s yogurt failure. Or Coca-Cola’s “New Coke” flop.

Cosmo pulled the yogurt off the market within 18 months.  Consumers demanded that Coca-Cola return to the original Coke recipe.

Could it be possible that CSC has 2 product failures???

The Lorenzo system???

AND

NCTracks????