April 2, 2007
Pay gap | With a June deadline looming, the state's 7,000 MaineCare providers work to balance the books
By Sara Donnelly
The Department of Health and Human Services in late February finally threw in the towel on its ill-fated Maine Claims Management System, dubbed MECMS, saying it would seek federal approval to replace the system. The move appears to be significant progress, but state healthcare providers battered by the years-long MaineCare billing fiasco now have to deal with a potentially messy reconciliation with the state.
That's because DHHS is stepping up its efforts to reclaim the $521 million in interim payments it sent to providers during the worst months of the MECMS crash. Providers say that means extra man-hours and potentially thousands of dollars in expense to sift through claims paperwork dating back to 2005.
MaineCare is the state's Medicaid program. It supports roughly 270,000 Mainers, or about one out of every five people, many of them low-income. About 7,000 healthcare providers in Maine, including physicians, dentists, and psychologists, accept MaineCare patients. The
billing crisis, which arose when the buggy MECMS program was implemented in January 2005 and immediately stopped processing claims, has cost Maine taxpayers more than $47 million in operational costs and driven some healthcare professionals out of business.
One of the most recent and most visible casualties of the continuing problems with the billing software came from the Saco behavioral health organization Sweetser. In February, about a week before the state announced its plans to purchase another system, Sweetser announced that it would lay off 43 of its 1,200 employees and close six of its 24 residence homes because of declining revenue that the agency says is due in part to the MECMS billing problems. Sweetser says it is owed around $5 million from MaineCare, though the state says the actual figure is closer to $1.6 million.
But horror stories like Sweetser's are still in the minority. The majority of providers have weathered the storm by trimming budgets, foregoing pay raises and perks, and postponing long-term expansion plans until MaineCare reimbursements become reliable. Most of them, especially providers like nursing care facilities and programs for the disabled that tend to rely on MaineCare for the bulk of their revenue, say the interim payments kept them afloat.
But the honeymoon phase of the interim payments is coming to a close. From January 2005 through Januray 2006, when the bulk of MaineCare providers relied on interims to make ends meet, the state mailed out these stop-gap checks to around 4,500 providers. About 1,200 providers have yet to pay the state back and now must spend the next few months sifting through paperwork dating back to 2005 to figure out what, if anything, they owe MaineCare. Providers have to reimburse the state for any double payments ˆ or interim payments for which they have also received claims payments.
Kirsten Figueroa, DHHS's Deputy Commissioner of Finance, is in charge of reclaiming the approximately $191 million in interim payments that remain in providers' hands. Since the interim recovery effort began in January 2006, the state has recovered $334 million. Figueroa hopes to recover another $70 million by the June 30 deadline. (Providers who have not returned their interim payments by the deadline could have the difference taken out of future reimbursements, Figueroa says.)
According to Figueroa, about 700 of the 1,200 providers currently working with the state may have been paid twice. Of the several thousand providers that at one time received interim payments, Figueroa says some were overpaid by several thousands of dollars.
Recovery period
From January 2005 to March 2006, in the wake of what providers say amounted to an abrupt standstill in claims payment, the state mailed what it calls interim payments to all MaineCare providers to prop up their bottom line until the MECMS program could be fixed.
Problem is, interim payments weren't calculated relative to each provider's claims. Instead, the state paid providers a fixed amount based on an average of the provider's past monthly payments.
As a result, the interim payments were sometimes higher and sometimes lower than the actual month's claims. (The state continues to issue interim payments on a case by case basis, though Figueroa says only two providers are currently receiving such payments.)
And besides giving back parts of those payments, many providers are saddled with extra costs just to figure out w hether they owe. "We've had to incur tremendous additional expenses to reconcile the massive data mess, what [the state] paid versus what they should have paid and then to follow up on that and try to get them to pay what they should," says Michael Stair, chief information officer of Elder Independence of Maine, a statewide homecare coordinator for the elderly with offices in Bangor and Auburn.
Stair estimates that dealing with MECMS-related issues, which includes reconciling the averaged interim payments with the actual claims, has cost his company more than $150,000 and he expects to spend at least as much more until the MaineCare billing system is fixed. Much of this money has been used to hire an outside programming firm to handle billing issues as they arise.
A staff of seven DHHS workers, known as the interim payment recovery team, works with providers like Elder Independence to compare DHHS's records of claims submitted with the providers' records. Many providers say the records don't match up, and they worry that the additional costs of paying staffers to sort through the interim discrepancies before the deadline will add more stress to their businesses, some of which are still awaiting thousands in unpaid claims dating back to 2005.
"I probably get a minimum of at least five to 10 emails a week with somebody with a MaineCare billing issue," says Mary Lou Dyer, executive director of the Maine Association for Community Service Providers, a Hallowell trade organization for Maine providers working with the mentally and physically handicapped. "That's the issue that most people are complaining to me about is getting to how much they're owed. That's the next big thing."
That's because DHHS is stepping up its efforts to reclaim the $521 million in interim payments it sent to providers during the worst months of the MECMS crash. Providers say that means extra man-hours and potentially thousands of dollars in expense to sift through claims paperwork dating back to 2005.
MaineCare is the state's Medicaid program. It supports roughly 270,000 Mainers, or about one out of every five people, many of them low-income. About 7,000 healthcare providers in Maine, including physicians, dentists, and psychologists, accept MaineCare patients. The
billing crisis, which arose when the buggy MECMS program was implemented in January 2005 and immediately stopped processing claims, has cost Maine taxpayers more than $47 million in operational costs and driven some healthcare professionals out of business.
One of the most recent and most visible casualties of the continuing problems with the billing software came from the Saco behavioral health organization Sweetser. In February, about a week before the state announced its plans to purchase another system, Sweetser announced that it would lay off 43 of its 1,200 employees and close six of its 24 residence homes because of declining revenue that the agency says is due in part to the MECMS billing problems. Sweetser says it is owed around $5 million from MaineCare, though the state says the actual figure is closer to $1.6 million.
But horror stories like Sweetser's are still in the minority. The majority of providers have weathered the storm by trimming budgets, foregoing pay raises and perks, and postponing long-term expansion plans until MaineCare reimbursements become reliable. Most of them, especially providers like nursing care facilities and programs for the disabled that tend to rely on MaineCare for the bulk of their revenue, say the interim payments kept them afloat.
But the honeymoon phase of the interim payments is coming to a close. From January 2005 through Januray 2006, when the bulk of MaineCare providers relied on interims to make ends meet, the state mailed out these stop-gap checks to around 4,500 providers. About 1,200 providers have yet to pay the state back and now must spend the next few months sifting through paperwork dating back to 2005 to figure out what, if anything, they owe MaineCare. Providers have to reimburse the state for any double payments ˆ or interim payments for which they have also received claims payments.
Kirsten Figueroa, DHHS's Deputy Commissioner of Finance, is in charge of reclaiming the approximately $191 million in interim payments that remain in providers' hands. Since the interim recovery effort began in January 2006, the state has recovered $334 million. Figueroa hopes to recover another $70 million by the June 30 deadline. (Providers who have not returned their interim payments by the deadline could have the difference taken out of future reimbursements, Figueroa says.)
According to Figueroa, about 700 of the 1,200 providers currently working with the state may have been paid twice. Of the several thousand providers that at one time received interim payments, Figueroa says some were overpaid by several thousands of dollars.
Recovery period
From January 2005 to March 2006, in the wake of what providers say amounted to an abrupt standstill in claims payment, the state mailed what it calls interim payments to all MaineCare providers to prop up their bottom line until the MECMS program could be fixed.
Problem is, interim payments weren't calculated relative to each provider's claims. Instead, the state paid providers a fixed amount based on an average of the provider's past monthly payments.
As a result, the interim payments were sometimes higher and sometimes lower than the actual month's claims. (The state continues to issue interim payments on a case by case basis, though Figueroa says only two providers are currently receiving such payments.)
And besides giving back parts of those payments, many providers are saddled with extra costs just to figure out w hether they owe. "We've had to incur tremendous additional expenses to reconcile the massive data mess, what [the state] paid versus what they should have paid and then to follow up on that and try to get them to pay what they should," says Michael Stair, chief information officer of Elder Independence of Maine, a statewide homecare coordinator for the elderly with offices in Bangor and Auburn.
Stair estimates that dealing with MECMS-related issues, which includes reconciling the averaged interim payments with the actual claims, has cost his company more than $150,000 and he expects to spend at least as much more until the MaineCare billing system is fixed. Much of this money has been used to hire an outside programming firm to handle billing issues as they arise.
A staff of seven DHHS workers, known as the interim payment recovery team, works with providers like Elder Independence to compare DHHS's records of claims submitted with the providers' records. Many providers say the records don't match up, and they worry that the additional costs of paying staffers to sort through the interim discrepancies before the deadline will add more stress to their businesses, some of which are still awaiting thousands in unpaid claims dating back to 2005.
"I probably get a minimum of at least five to 10 emails a week with somebody with a MaineCare billing issue," says Mary Lou Dyer, executive director of the Maine Association for Community Service Providers, a Hallowell trade organization for Maine providers working with the mentally and physically handicapped. "That's the issue that most people are complaining to me about is getting to how much they're owed. That's the next big thing."
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