Posted by Behavioral Health Billing Solutions, LLC.
It’s been a busy week in Ohio Behavioral Health. ODM is seeking public input from individuals and providers on how the current Managed Care process is working. Interesting request. Simple answer; its not. The MITS BITS that went out yesterday with the request is availablehere.
This week at BHBS we discovered a number of things that are problematic.
1. One MCO is sending out a new denial reason that states “missing notes”. And even though we have been reporting that as an incorrect denial, the agency receiving them reached out to them and they said all payments were on hold. This agency hasn’t been able to pay employee’s for 3 weeks and recently was hit by a tornado. June has not been their month and if we are unable to resolve and get them paid quickly, it may be their last as a Behavioral Health Agency. And that is unacceptable. This is one of our clients and although we have been working and reporting incorrect denials on a weekly basis to all MCO’s, they simply are not being resolved. Now one of OURS, may not make it. Trust me, I am doing everything in my power to ensure that doesn’t happen.
2. Another MCO has continued to send out payments for agency services on checks made out to providers. This was reported June 3rd and now they are up to 20k. Due to the response I received late yesterday that confirmed the issue was reported and escalated, we were told it could be 15-30 days before it is resolved. Guess what? That’s unacceptable. I told the agency to deposit the checks and let the MCO figure it out on their end. We had to swear on a bible to our providers that if they completed a W-9 under their name, they would not be charged for services billed and paid by the agency and now it’s happened at least 9 times.
3. In trying to follow up on our discovery from a couple weeks ago about CareSource, Molina and UHCCP not sending denials in their 835’s, I reached out to all 3 requesting complete claim listings for our clients. Molina and UHC immediately complied, however, CareSource said their attorney and compliance team advised them against it since agencies had another resource, Instamed, to pull the data. Unfortunately, I proved that the information in Instamed is exactly what is in the 835 so it is wrong. Still nothing.
4. I met with Medicaid this week and actually I thought it was very productive. First time I’ve left a meeting at Medicaid where everyone was smiling.
However, although many issues were discussed, one stood out like a sore thumb. For our clients on CareLogic, our system admin created a report that gives the life cycle of a claim. We use it for many things including “pended claims”. Pended claims are ones that show as billed but there has been no response in 60 days. We even give them a little extra time just to be sure. But when that was displayed, client after client, an executive in the meeting asked “I’m a bit confused. The MCO’s told me all of July, Aug and September claims were paid 3 weeks ago”. I replied that our financial reports were updated AFTER pulling in 835’s for each client on the friday before our meeting so the data is current.
We run pended reports and get them to the MCO’s monthly. And honestly, I don’t think they’ve changed very much at all but I can guarantee you that July, August and September claims are NOT fully paid in any way.
5. I had my bi-weekly call with one MCO yesterday and I brought up their folder where we submit incorrect denials and short pays for our clients, of which there are new ones every week and I asked them if they could tell me if these submissions had been processed and paid.
I said is anyone even looking at them?
The answer was yes they are reviewing but none have been re-processed yet. The denial reports are from several months so my voice might have got a little louder when I replied that we are doing the best we can to keep our clients in business but we can’t do it alone. We need the MCO’s to do what is expected, which is analyze and if denials or short pays are truly incorrect, FIX THEM.
I’m sure all agencies in Ohio are aware of the administrative nightmare it is to track denials and short pays at this time. Agencies are laying off providers and hiring administrative staff. That doesn’t sound like improving access to care to me. Does it to any of you?
Also, be aware that if you took a contingency payment to get through this yearlong nightmare, you will be called by a Medicaid representative to discuss a repayment schedule. IF you are struggling and have unpaid claims from the first six months of the Managed Care carve in, tell them that. Recoupment terms are negotiable. If it will cause a financial hardship for you, tell them that and tell them why. See here for more details of contingency plan recoupments.
Below is the detail of what information ODM is asking for input. Take time to make your voice be heard.32>
Ohio Medicaid Seeks Public Input on Making the Program Work Better
The Ohio Department of Medicaid (ODM) yesterday released a request for information (RFI) to gather public input as ODM begins the process to select new managed care partners. ODM’s first step in the process is collecting feedback on current Medicaid services, what is working and ideas for improvement.
Feedback is being sought from individuals and providers in multiple areas, including:
• How managed care organizations communicate and support individuals and providers
• What benefits are most helpful
• How to best coordinate individual care
• How to file complaints and appeal managed care organization decisions
All feedback is important and will be considered throughout this process. Anyone that would like to share their experience with the current Medicaid managed care program or ideas and solutions for the new program are able to submit feedback through the RFI webpage.