During the final week of August, Jordan Karimi was spending his days cleaning up the office, making final phone calls and saying goodbye to co-workers.
Karimi, 28, had worked for his parents for the past five years. Their company, Right at Home, had provided home health and personal care to the elderly and people with disabilities in Granite Falls. Karimi handled the billing.
But now Karimi is out of a job and his parents are out of business after a decade. The reason? They weren’t being paid for the Medicaid-reimbursed services they delivered in July and August after the state rolled out its new Medicaid payment system, known as NCTracks.
“It’s just all financial,” Karimi said in an interview in late August. “We can’t even make our payroll. We’re a week and a half behind, and we need that money.”
Karimi and his parents are among the many Medicaid providers who say their businesses are increasingly in jeopardy as a result of computer glitches, delays in getting responses and payment problems generated by the new half-billion-dollar computer system.
From individual physician practices to large metropolitan hospitals, Medicaid providers around the state are finding themselves asking their bankers for loans or lines of credit, using up reserves or, as in Karimi’s case, closing since NCTracks came online.
“The economy is not great at the moment,” said Karimi, who was unsure what he would do as he joined the ranks of Caldwell County’s 9.9 percent of the workforce unemployed. His parents’ company employed about 40 people.
“We were ignored, basically,” Karimi said. “We called – we’re still calling. We called this morning, even as the movers were cleaning out the office.”
But they never got results.
During an Aug. 23 meeting of the Medical Care Advisory Committee, a federally mandated committee of Medicaid providers from around the state, Medicaid officials said that hardship payments were available for providers who were having trouble getting paid by the system.
“That’s the first time I’ve heard about it,” Jean Kirk, head of N.C. Foot and Ankle Society, an umbrella group for podiatrists, said during the meeting.
Kirk said podiatrists – who are important caregivers, especially for patients with diabetes whose circulation problems mean they have many foot problems – have been calling her for help in getting paid by NCTracks.
Kirk said doctors treating patients who qualify for both Medicare and Medicaid have had a particularly hard time getting reimbursed for care.
“The Medicaid part of the bill is not getting paid,” Kirk said. “We’re talking about people who don’t have that money to spare, so the docs can’t bill it to the patient. That would be a violation of the Medicaid contract.”
She said she’s heard from dozens of podiatrists who haven’t been paid since NCTracks went online on July 1.
“I also have providers who haven’t been paid since June – and even May – because they were told to hold off on billing in late June as they got the system ready for transition,” Kirk said.
“No one I’ve talked to has gotten a callback from a supervisor, even after they reach someone at NCTracks,” she said.
Christi Jenkins Peugh, a professional coder at Salisbury Pediatric Associates, said the Medicaid claims she submitted to the state got paid in the first few weeks of July. But then she said her office’s provider number for laboratory services “somehow got changed,” and the claims began to be denied.
She added that she got little help from state officials with NCTracks.
“We call up there. No one knows answers to anything. We leave messages. We send emails. We get no response back,” Peugh said.
In Charlotte, Sally Pidge runs Achieve Therapy Services, which offers speech and occupational therapy to children. She has also had problems with the new system.
When NCTracks took over, she was unable to bill for some services for about 10 weeks. “Each time we fixed one thing, something else happened,” she said.
At one point, NCTracks mistakenly identified her practice as a “birthing center.” At another point, the system showed that several of her therapists had been “terminated” when they hadn’t been. Another mistake was when the computer showed that one of her therapists worked for an agency in Gastonia; she hasn’t worked there for four years.
Because of these problems, Pidge’s office couldn’t file for $57,000 worth of claims from July 20 through Sept. 3.
She finally got the problems figured out in early September and is now getting paid, but she couldn’t believe how hard it was and how long it took.
“I had to go through the governor’s office, and then you had to go up and up and up (inside NCTracks) until you finally got to where somebody would fix it,” Pidge said. “I expected it to be a mess for like two weeks, not two months.
“They have no hesitancy sending people out to our facility to make sure that we’re compliant with state regulations. …We have to be held accountable, but I think they need to be held accountable, too,” Pidge said. “I just want to get the services to the kids that need it. That’s, in the end, who’s going to get hurt.”
And it’s not just small providers who are having trouble.
In an interview last week, WakeMed CEO Bill Atkinson said his institution was down $1.5 million since July 1 because of NCTracks. He worried that his billers would have to re-submit all of those claims by hand.
In an email to North Carolina Health News, Department of Health and Human Services communications chief Ricky Diaz said, “I did some digging and it seems that WakeMed was using the wrong number in the system, which is why they were behind. Our folks continue to work closely with them to teach them how to use the system.”
“We recognize that some providers are experiencing challenges with the transition,” Diaz added.
According to department statistics, 1.5 million professional claims were made during the first three weeks of August. Only 36 percent of those claims were approved; the departmental target was 65 percent. The department also missed other internal goals for the system.
“DHHS and its vendor, CSC, continue to address technical glitches and providers’ issues with the new claims system,” Diaz wrote. “Teams at DHHS are proactively calling those providers who are having the most difficulty with taxonomy and walking them through the steps necessary to successfully process claims and ultimately get paid.”
Amy Slattery, a medical biller in the office of Statesville OB-GYN Michael Kepley, said she was ready to drive the two hours to Raleigh and sit in CSC’s lobby if that’s what it takes to get attention from the computer company.
She was one of the providers who sat through two days of training in Raleigh in June to prepare for the transition; she thought she would be fine.
“Our issue is that we’re having trouble getting responses,” Slattery said this week.
“If you call CSC, the hold time is over an hour, so I stopped calling them,” she said. “I’d logged several cases with NCTracks, and then waited weeks for a response.
“So I called the governor’s office. Within two hours, I had a representative from NCTracks call me, but he was not helpful … and I’ve not heard from him since.”
Slattery called the governor’s office again, and got a quick response from CSC.
“Then a representative from NCTracks called, and she was supposed to be our liaison. She was helping me with some of the smaller issues that we were having. That was during August, and we got some payments.”
It turned out that the practice had two provider identification numbers, and only bills filed on one number were making it through the system. So Slattery started submitting bills through that number and attempting to resolve the problems with the other number.
In order to submit bills under the correct number, Slattery was told she would have to go through another two-hour training. She’s been trying to register for the training for the past month without success.
“Never once have I seen a mess as big as this,” she said. “We were ready to go live with an electronic health-record system, but we’ve had to put every single aspect of our practice on hold.
“We can’t put in any more time or attention into anything else right now.”