North Carolina: NCTracks fix spells relief

There's still work to do, however
Friday, April 24, 2015

RALEIGH, N.C. – Billing for patients with both Medicare and Medicaid got a little easier on March 1 for HME providers in North Carolina.

A glitch in NCTracks, the system that processes claims for the state’s Medicaid program, meant providers had to manually correct rental claims for these so-called dual eligibles.

“It’s money that we had tied up in A/R, and extra cost and time, that we won’t have anymore,” said Craig Rae, owner of Penrod Medical Equipment in Salisbury.

A fix to the system, in the works for nearly 20 months, now allows Medicaid to pay for rental claims for a full month, instead of one day. What tripped the system in the first place: Medicare pays by the month, Medicaid pays by the day.

While the fix resolves the majority of issues, there still appears to be a “minor hang-up” in the system for claims for diabetes supplies, says Andrea Stark.

“It still can’t process a future through date,” said Stark, a reimbursement consultant for Mira Vista. “Even though Medicare allows you to bill from the ship date, Medicaid requires you to bill at the end of a utilization period.”

Additionally, the North Carolina Association for Medical Equipment Services would like to see some retroactive relief, says Beth Bowen, executive director. 

“NCAMES is still working with (Medicaid) to attempt to have all Medicare crossover claims subject to cost sharing that were processed by NCTracks prior to March 1 to be reprocessed to reimburse providers for the entire Medicare cost sharing amount,” she stated in a bulletin to members.

The likelihood of that happening is good, Stark says.

“While no timeframe was set, the initial conversation with Medicaid suggested they are considering a mass adjustment of underpaid claims remaining from the prior 20 months,” she said. hme