Colorado’s Glitchy New Medicaid Payment System Has Some Doctors Declaring ‘Crisis’ | CPR

Practices across the state have done financial gymnastics to stay afloat after the state’s Medicaid agency started to erroneously reject claims.

This is absolutely nothing short of pathetic. These doctors get paid almost nothing by Medicaid and it’s taking over 3 months for them to get paid.

Gov. John Hickenlooper, a Democrat, recently said the state wants the problems fixed.

“We will make sure that everyone gets their money. Guaranteed. Everyone will get the money which they are entitled for,” Hickelooper said. “Clearly making people wait three months to get paid is unacceptable. There’s no question about that.”

And Hickenlooper worries about hurting some of the state’s “most strongly committed and passionate” providers. “The last thing we want to do is penalize them for taking on their Medicaid patients,” he said. “We want if anything to reward them and make their lives easier.”

And here’s what one doctor did to meet payroll…

Dr. Jan Gillespie, an anesthesiologist in Greeley, said she’s waiting for about $100,000 in back claims. She stopped paying herself and loaned her practice money to make payroll. Nearly 40 percent of her patient mix is enrolled in Medicaid.

“I personally feel the passion to take care of those people,” said Gillespie. “But [the state is] making it impossible. I can’t do it if I have to appeal every claim to get paid.”

So my question to Chris Underwood, office director of the health information office for the state’s Department of Health Care Policy and Financing (HCPF), is do you have any idea how to manage a large software development contract or do you simply hire a contractor and wash your hands of it. Are there incentives and penalties in the DXC Technology contract? Why is it OK to effectively use the Medicaid providers as guinea pigs? What right do you have to bring financial Armageddon onto their practices?

Of course, all of this is because of the Affordable Care Act?

Underwood acknowledges the problems, which include coding errors and providers who’ve struggled to successfully navigate the complex new system. He said once it’s fully performing, the system will be more flexible and precise, meeting new requirements under the Affordable Care Act to combat waste and fraud.

When it launched, providers had to be revalidated. “The number one reason we still have denied claims is because providers are not enrolled correctly or they’re not billing from the proper location,” Underwood said.

The department says it’s paid more than $3 billion in claims, and that just a small percentage of providers are still having problems. It’s beefed up its call center and wait times are down sharply. Underwood said it’s working one on one with about 200 providers. It’s even offered financial help of nearly $23 million to those who are still having problems with the vendor, DXC Technology.

Time and time again, government agencies underestimate the complexity of the software tasks they are asking contractors to accomplish. Let me give you a big hint, the kinds of errors that are occurring are direct a direct result of the weaknesses in project management and communication between HCPF and DXC Technology.

This is disgraceful.

Also, as a hint to author John Daley who apparently doesn’t have a public email address, there are similar incompetence issues in the state marketplace and in the HCPF system that determines Medicaid eligibility. However, the people affected are not doctors with a voice, but simple members of the public scattered throughout the state. They have no voice.