Blog Archives
August 5, 2013: DHHS says, “NCTracks on Track”…Really?
After reading the following DHHS release, I was so happy and comforted to know that NCTracks is on track! Thank goodness all, or most, Medicaid providers are receiving payments now. (It’s called sarcasm, people).
(blog on my thoughts regarding today’s release to come tonight…)
Raleigh, N.C. –
NC Tracks, the Department of Health and Human Services’ (DHHS) new claims system, recently completed its first month of operations, processing more than 15 million claims and paying health care providers more than $750 million during July. NCTracks, which pays state Medicaid and other claims weekly, finished its fourth payment cycle of July, compared to three payments in a typical month under the 35-year-old previous system.
Payments to North Carolina healthcare providers in July 2013 totaled $758 million under the new NCTracks system. While the system has successfully processed and paid millions of claims, DHHS and its partner, CSC, continue to address technical glitches and providers’ issues with the new claims system, as expected.
“We’ve said all along that this is not going to be a simple conversion, that it’ll take 30, 60, maybe 90 days until everyone’s comfortable with it,” said Joe Cooper, DHHS Chief Information Officer. “The good news is that after the first month, the system is working and we are doing everything we can to help providers through this transition to get paid.”
Although some providers may still be experiencing difficulties with claims or payments, others have grown to appreciate the improvement NCTracks represents over previous claims systems.
“The first week was bumpy, but we are doing well now,” said Jean Koehn, CEO of Visiting Respiratory Care of Four Oaks. “The system is great! We know immediately if we will get paid or not on a claim.”
The single biggest issue keeping providers from getting paid is taxonomy, the system of medical codes that NCTracks uses to determine whether a provider has the proper credentials to bill for the item or procedure on a claim. To assist providers with taxonomy issues, DHHS and CSC continue to hold additional training, both in-person across the state and online, as well as proactively reaching out to providers, associations and third-party billing agents to walk them through the steps necessary to successfully process claims and ultimately get paid.
“Transitioning to a new, taxonomy-based system is like getting a new cell phone which may not have the same apps or be as intuitive to use initially,” added Joe Cooper, DHHS Chief Information Officer. “We understand the importance of timely reimbursement to providers, and after one month of operations, continue to work closely with the provider community to successfully transition them to the new system.”
The second most common reason for a provider not getting paid is missing or incomplete bank account information. Last week, more than 1,100 paper checks were mailed to providers who were missing their bank account information. This week, approximately 900 providers who continue to have issues with electronic banking will be mailed paper checks.
Other provider issues are being handled as they occur, many on a one-on-one basis.
As provider issues are resolved, wait times at the NCTracks Call Center (1-800-688-6696) continue to improve. Average answer times are down to around 17 minutes, well below the lengthy hold times a few weeks ago. CSC continues to hire and train additional Call Center staff to address providers’ needs.
WRAL Cites NCTracks Problems
I did not write this. I am cutting and copying from WRAL. This was on the 5:30pm news today, August 1, 2013:
RALEIGH, N.C. — More than 400 medical providers in North Carolina attended a training seminar in Raleigh on Thursday to learn how to use a new statewide billing system for Medicaid called NCTracks.
Some providers attending the session said the state owes them as much as $130,000 in claim, since the $480 million system was rolled out to users on July 1.
NCTracks, which replaces a 35-year-old computer system, uses different identification numbers for various products and services than the old processing system, and the billing software some providers use isn’t compatible with the new numbering system.
That is forcing providers to manually enter claims into the state system one by one instead of submitting dozens in a single batch.
Another issue keeping providers from getting paid is that they have not updated their electronic fund transfer information in the new system.
“We just feel like this could have been better implemented, because, if we don’t have money to pay our staff, we can’t provide a service for our patients,” said Teresa Oudeh, an administrator at Oudeh Medical Plaza in Dunn. “We just think it’s unreasonable and outrageous.”
The North Carolina Department of Health and Human Services predicted a rough transition when it launched the NCTracks, but spokesman Brad Deen said he’s not sure what could have been done differently.
The system has processed claims totaling about $38 million for approximately 900 providers without any problems, he said.
Prior to launching NCTracks, DHHS held training seminars across the state from April to June. At the Raleigh session, about 20 people attended.
“We sent emails. We sent individual letters. We held training sessions, which were lightly attended,” Deen said. “The only thing to do is what we’re doing now, which is to bring people up to speed.”
In recent weeks, DHHS has set up a call service center for providers, some of whom have said they have had to wait hours on the phone only to find that the service representative doesn’t have an answer for their questions.
“When you call to get answers, they cannot provide you with the correct answer,” said Christy McCartney, with Triangle Physicians for Women in Cary. “Every time you call, you get a different answer. So the folks who are supposed to tell us what to do, don’t know what to do.”
Since then, DHHS has hired more staff and extended call center hours.
It also has put in place a response team of 20 people to identify and reach out to providers not getting paid to resolve the problems.
Deen said DHHS is also planning future seminars across the state, but he couldn’t say when.
“We are doing everything we can to make sure people have the information they need to file claims successfully and get paid,” he said.
NCTracks, Monetary Damages, and Kudzu
So many providers in North Carolina who accept Medicaid have contacted me asking whether they have a legal case to bring a lawsuit against Computer Sciences Corporation (CSC), the company who created and is running NCTracks, for monetary damages.
In order to determine whether grounds for a lawsuit exist, you need to determine, generally: (a) Did CSC have a duty to timely pay Medicaid reimbursements to you; (b) Did CSC breach that duty; (c) Did you suffer monetary damages?
42 C.F.R. 447.45 states, in pertinent part, (a) Basis and purpose. This section implements section 1902(a)(37) of the Act by specifying—(1) State plan requirements for—(i) Timely processing of claims for payment…”
What does “timely” mean?
- The agency must pay 90 percent of all clean claims from practitioners, who are in individual or group practice or who practice in shared health facilities, within 30 days of the date of receipt.
- The agency must pay 99 percent of all clean claims from practitioners, who are in individual or group practice or who practice in shared health facilities, within 90 days of the date of receipt.
90%….within 30 days. Let’s see…last payments were June 20, 2013. It is July 26, 2013. No payments have been rendered to many providers in 36 days, and, according to one provider, he was told that he will receive reimbursement for at least another 2 weeks.
Hmmmmm….I do not think NCTracks is adhering to the 30 day rule. That said, if I were the attorney for NCTracks, I would argue that the providers not receiving payments within 30 days were not submitting “clean claims,” to which I, as myself, would say, “Prove it.”
I don’t think the Department of Health and Human Services (DHHS) is intentionally not paying providers Medicaid reimbursements for services rendered. I don’t think that DHHS meant for NCTracks to not pay some providers.
Regardless of intent, it is correct to say that DHHS went “live” with NCTracks without a “live” trial run and without conducting proper tests necessary prior to going “live.”
According to the May 2013 State Auditors’ Performance Audit of NC DHHS’ Implementation of NCTracks:
The Department has failed to fully test the system, and the production testing process has flaws.
• Key decisions about the addition of 1,500 user accounts and privacy and security procedures have yet to be made, increasing uncertainty about project readiness.
• A vendor hired to oversee the project did not conduct independent verifications as expected by the federal agency that administers Medicaid, and another vendor was permitted to set its own guidelines for whether its work was acceptable.
• No formal criteria exists to determine whether the new system is ready to go-live.
Why DHHS pushed NCTracks to go “live” on July 1, 2013, despite obvious concerns cited by the State Auditor, we may never know. It reminds me, somewhat, of kudzu and the fact that humans like to think that everything is controllable.
Kudzu is not native to America. Kudzu was originally introduced to America from Japan at the Japanese pavilion in the 1876 Centennial Exposition in Philadelphia. Kudzu was touted as a high-protein content cattle fodder and as a cover plant to prevent soil erosion. So people planted kudzu, thinking that kudzu would be an asset to our environment. Instead, kudzu had drastic negative effects on our environment. Kudzu is often dubbed “The Vine That Ate the South.” It has spreads at the rate of 150,000 acres (61,000 ha) annually.
The problem with kudzu is that kudzu kills or damages other plants by smothering them under a blanket of leaves, encompassing tree trunks, breaking branches, or even uprooting entire trees. Kudzu’s ability to grow quickly, survive, and acquire resources quickly allows it to out-compete native species.
So, think about it, we wanted kudzu because we thought kudzu would be a good thing. We did not research kudzu’s growth rate or kudzu’s interactions with American foliage. We did not perform test sites of kudzu to analyze the effects of kudzu on our environment. We didn’t even grow kudzu in a controlled environment to determine whether kudzu’s rate of growth would negatively impact our plants. Oh no, we saw kudzu, and, like a kid in a candy store, we said, “Oooohhhh….we want kudzu!” So we planted kudzu. We thought we could control kudzu.
I don’t think the Japanese, who introduced kudzu, nor the Americans, who accepted the kudzu, intentionally planted kudzu in order to kill plants and trees. I don’t think that the people who planted the kudzu meant for kudzu to have drastic negative consequences to our environment.
Regardless of intent, people who planted kudzu did so without fully testing kudzu’s impact on our environment.
In reality, kudzu is estimated to have lost us approximately $100–500 million per year in forest productivity…as in what we could have made by trees actually growing. In addition, it takes about $5,000 per hectare (2.5 acres) per year to control kudzu. For power companies, it costs about $1.5 million per year to repair damage to power lines. See Forseth. Jr., I.N. and Innis, Anne F.“Kudzu (‘‘Pueraria montana’’): History, Physiology, and Ecology Combine to Make a Major Ecosystem Threat” Critical Reviews in Plant Sciences, Vol. 23, 401-413, 2004.
Similarly, DHHS (regardless which administration) saw a new computer system, NCTracks, and like the kid in the candy store, said, “Ooooohhhh…we want NCTracks!” So we purchased NCTracks. We thought we could control NCTracks.
We certainly did not perform all necessary tests on NCTracks before going “live.”
Now, due to the failure to fully test NCTracks and the “glitches” surrounding NCTracks, NCTracks, like kudzu, is producing drastic negative effects on our health care providers. Some providers are losing hundreds of thousands of dollars per week due to NCTracks. One provider told me that he already closed one location and terminated 6 staff due to NCTracks.
NCTracks is not, at least for many, many health care providers, timely paying Medicaid reimbursements.
But what are the monetary damages? What if you file a lawsuit against CSC and the day after you file a lawsuit you are paid in full? Do you still have any damages?
It depends.
I got an email from a pediatric physician; we will call her Amy. For the past few weeks, Amy has been unable to sleep. She has not been paid since June 20, 2013. Unlike most providers, she does not limit the number of Medicaid recipients at her practice, and Medicaid is 85% of her income.
Amy spent her one-week-long vacation on-hold with NCTracks 70% of the time. She is behind on work. She has decreased her clinical hours. Amy was forced to ask her parents for a loan to make payroll, and still has not paid all her staff completely.
Last week, Amy and her husband did not have enough money for groceries until her husband was paid on Friday.
Yesterday, when Amy contacted NCTracks, she was told that, according to NCTracks’ records, Amy was paid. But no money is in Amy’s bank account.
Even if Amy were paid tomorrow by NCTracks, don’t you think that Amy suffered additional damages?
Maybe we should just plant a bunch of kudzu around NCTracks and CSC.
