Medicaid case backlog won’t be cleared soon

Wednesday, June 23, 2004 | 9:02 a.m.

Nevada Medicaid officials said Tuesday that a plan to have cleared a backlog of more than 170,000 unpaid claims by July 1 now appears unlikely.

A number of computer snafus set the state agency responsible for paying doctors back on payments, some dating as far back as October. The agency is still working to pay claims from October to December, which must be processed manually because of the glitch.

The plan is now centered on paying more current claims, while at the same time processing older claims, Charles Duarte, administrator for the Nevada Division of Health Care Financing and Policy, said.

Area physicians and medical groups previously said the reason Medicaid and its contracted provider, First Health Services, are meeting the current workload is because many doctors are "sitting on Medicaid claims," waiting to see if the problems have been resolved before wasting their time submitting them.

However, Duarte described First Health's pace as "slow for our liking," saying that the provider will face penalties for overdue claims beginning July 1.

"Progress is being made (on the claims) but not at a pace warranted to not hold First Health's feet to the fire," Duarte said of the penalties.

Duarte is scheduled to address the issue Friday morning at the state Board of Health meeting in Carson City. It begins at 9 a.m. and will be broadcast to the Sawyer State Office Building in Las Vegas.

Medical officials had said they hope Medicaid will start paying doctors in a more timely manner, even after the state failed to meet deadlines in March and April for catching up with the workload.

"In January we realized there was a (computer) problem and by March we realized the problem was much bigger than anyone previously had thought," said Larry Matheis, executive director of the Nevada State Medical Association. "It was just a colossal set of problems."

Matheis said he has had weekly meetings with state Medicaid officials for 20 consecutive weeks trying to hammer out a solution. He said, if the matter was not quickly resolved, it could result in doctors dropping Medicaid patients, which include numerous poor families, especially children.

The Nevada State Medical Association estimated that area doctors are owed $15 million from the backlogged Medicaid system.

Recently, the legislature's Interim Finance Committee approved taking $20 million from Medicaid's $1 billion 2005 fiscal budget, to cover an end-of-fiscal-year shortfall and pay doctors what they are owed.

The problems that led to the dilemma include:

Those problems triggered a decision late last year to give cash advances to doctors and hospitals for treating Medicaid patients, to hold them over until the kinks in the system could be worked out. The money was to be repaid via deductions from the backlog of claims that were yet to be processed.

Medicaid officials said a number of doctors declined to take advantage of the offer because of potential bookkeeping problems, figuring out which money from which claims was put toward repayment of the cash advances.

Debbra King, finance deputy for the Division of Health Care Financing and Policy, which oversees Medicaid and First Health Services, said workers were plugging away "continuously working through the identified issues."

Those include working the bugs out of the Medicaid Management Information System computer -- Nevada was the last state to install it -- and coming into compliance with new federal guidelines for patient confidentiality of electronic data.

Matheis said doctors are hesitant to file claims until they are sure the computer system will accurately process them in a timely manner.

"The current claims are what have been submitted in just the last three months," he said. "Based on that little amount of time, it's hard to know if the problems have been fixed or if there are just far fewer claims to process.

"In fact, many doctors are sitting on Medicaid claims waiting to see if the problem is cleared up."

Matheis said Medicaid generally accounts for about 10 percent of an average doctor's business -- if that doctor accepts Medicaid patients.

Dr. Ed Kingsley, a Las Vegas oncologist, said his company, Comprehensive Cancer Centers of Nevada, used to take Medicaid patients but no longer does.

"It is difficult and discouraging for many doctors who want to treat Medicaid patients. The hassle is just too great."