New Medicaid computer system doesn't end errors
It is causing ongoing frustration, with no end in sight, according to Bruce Burns, Concord Hospital's chief financial officer.
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.
It is taking far too long to get up and running, Burns said. "It was not well-managed through this process," 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.
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."
"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.
"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."
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.
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.
"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.
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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