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.
