Computer system bugs providers

Thursday, August 31, 2006

PORTLAND, Maine - Frustrated with delayed payments totaling hundreds of thousands of dollars and a lack of answers, Maine HME providers recently asked the governor for help.
In a recent letter, the New England Medical Equipment Dealers (NEMED) association asked Gov. John Baldacci for a meeting to address issues with the MaineCare program. The problems stem from the November 2004 installation of a new computer system that flags claims.
Gov. Baldacci's response? He passed it along to "the people who handle this," said Jim Greatorex, owner of Portland-based Black Bear Medical.
With his company waiting on about $180,000 in payments over 60 days old, Greatorex describes the system as "a mess."
"We've lost all confidence in the ability to process transactions," he said. "We supply proof of nonpayment and they're trying to figure out why it wasn't paid."
The state plans to "force" through individual claims, said Greatorex. The claims will get flagged and software techs will then write corrections for the individual claims.
To ease the money crunch for providers, the state has been issuing interim payments--a lump sum based on a provider's MaineCare claims from the previous year. But, with no way to apply the money to specific claims, the interim payments are at best a stopgap solution, says Tyrrell Hunter, president of Topsham-based Majors Mobility.
"At some point, we need to reconcile (the books)," said Hunter.
Sean Welton, president of Community Oxygen Services in Damariscotta, said in the future his company might have to rethink who it accepts as patients.
"There's going to come a time when we don't know if we're going to be able to take care of MaineCare recipients," said Welton.