“Billing System Issues Remain: Error Discovered in Medicaid Raid”

“Billing System Issues Remain: Error Discovered in Medicaid Raid”
In reference to the original article written by Anna Harvey in the News and Observer on Sunday September 22, 2013
Morehead City
Emily F. Kelly, author

NCTracks is the Medicaid billing software for which area hospitals and medical offices have implemented computerized Medicaid billing for patients and presumably receive reimbursement by Medicaid for their physicians. Tammy Lenhart, a Carteret County billing expert who is employed by A+ Medical Billing Services, Inc., discovered a hidden rate cut for physicians treating patients on Medicaid. The billing system error causes Medicaid to be treated as a second insurance policy, presumably making it more difficult to bill for the services rendered to these types of patients, but the main problem is that physicians are being reimbursed only 15-29% of what they were previously being paid on the old system, (or, for example, the service for a new Medicaid patient as a secondary insurance policy will pay the provider just $6.28, whereas the old system paid them $23.24). The problem seems to lie in the authorization of certain taxonomy codes, which are codes that are used to identify the services rendered by a doctor billing a patient; and the way this is done is by setting the system up to treat Medicaid as secondary insurance. It appears that someone installing or programming the software has authorized this rate cut by authorizing these new taxonomy codes that does not comply the same way the old ones did. The result of this error has been the disruption to patients’ medical care because physicians are essentially turning Medicaid patients away from the lack of payment they receive. Dr. Margaret Merrick, President of the Carteret County Medical Society is quoted in saying, “The disruption to [the patients’] medical care that has been caused by the NCTracks train wreck…it’s a crime”.

            Drawing inferences through speculation, it would appear that the implementation of help from Carteret County’s Rep. Pat McElraft and Sen. Norm Sanderson and Ms. Lenhart’s employment of several outreach attempts to Governor Pat McCrory’s office, the representatives of the software and the investigation pending by the Department of Health and Human Services, all with little to no response, has been leading to the conclusion that this may be a political issue. There is certainly suspicion that in recent news, Pat McCrory has opted out of Medicaid expansion in North Carolina; the DHHS is investigating the issue but not helping it and the Republican agenda seems to be to cut Medicaid by a long stretch in their effort to “ween” NC citizens off of government assistance, this software glitch is a convenient factor in achieving this cause. However, thankfully, Ms. Lenhart was savvy enough to have noticed the glitch, most likely once her office began receiving the reimbursement from Medicaid and noticing how little the amount was.

           

            

The Abortion Contradiction

  The recent legislation passed on restrictive abortion procedures in North Carolina (which you can read here: http://www.washingtonpost.com/blogs/post-politics/wp/2013/07/29/nc-gov-mccrory-signs-anti-abortion-bill-into-law-monday-night/) has many on the edge of an infuriated rant. When NC Governor Pat McCrory tried to pass a plate of cookies to protesters outside of the Governor's Mansion in an effort to "become friends", although he would certainly not change his position, was received as a devious insult to those who responded, "We want women's health care, not cookies". The Washington Post reported that, "among other provisions, will make clinics adopt some of the regulations that apply to ambulatory surgery centers, and allow health-care providers to opt out of performing abortions if they object", (http://www.washingtonpost.com/blogs/she-the-people/wp/2013/08/01/north-carolina-gov-pat-mccrory-gives-protesters-cookies-seriously/). The sad confession I make is that I actually voted for this man. I believed that he had created a positive, entrepreneurial change in Charlotte, NC and that he could mirror that same success here in Raleigh. 
  I also believed that McCrory was a moderate Republican. These days, it seems as though there are no "moderate" Republicans left in North Carolina. I suppose my own definition of "moderate" was a Republican that could separate his religious beliefs from the law, the legislation and the wishes of the people. He has hopped on the bandwagon of radicals that believe that their moral victory lies in the bridging of the two and to advocate for the life of an unborn fetus. While this may be a noble pursuit, there is no logic in the argument and in the formation of the law. The belief that one should take the power out of the hands of the woman carrying the child is a daunting feat that simply displays an ignorance of the situation and a lack of understanding that results in more harm than good. The mother can make a decision in her first trimester,for example, that she is unable to care for the child and give it a good life. Perhaps if she had affordable access to birth control before the fact, this kind of decision would not have to be made. The contradiction in the argument against both birth control and abortion that many Republicans make has been pointed out by many. 
  This kind of restrictive access has other consequences as well. What many don't realize is that birth control has other positive effects besides preventing pregnancy. It can reduce the risk of ovarian cysts and cancer, reduce excessive menstrual bleeding and balance a woman's hormone production. It seems as though the facts do not outweigh the moral victory that comes from "promoting promiscuous behavior". Of course, there is no logical connection between using birth control and being a promiscuous woman. In fact, who cares? Sex is an integral and inevitable part of a human being, so why not practice it safely? If the legislature thinks they are truly going to somehow convince a sixteen-year-old to abstain from sex until they are getting married, they have another thing coming. The nanny-state concept has taken on a new meaning to legislators moving in on the role of the parents and the adults who make decisions on their own accord. Another contradiction in itself: they scream for less government, but they create more regulation for you...just their way. 
  Unfortunately in North Carolina, those who recognize these kinds of fallacies are not in the majority. That is why continuing the Moral Monday protests are essential to catalyzing change into the 21st century and eventually, becoming the productive state that I have come to love over so many years.