Slow reimbursement ties hands of Illinois providers

Sunday, April 30, 2006

FREEPORT, Ill. - Slow Medicaid reimbursement has some Illinois providers digging deeper into their own pockets and turning away patients in an effort to keep afloat.
"A lot of people are complaining that (payments) are six or more months behind," said Alan Kirk, vice president of Elgin-based Total Home Care. "We don't feel it's any worse, we've just learned to work around it."
But that's not so easy for some smaller providers. Carolyn Sluiter, owner of Freeport Home Medical in Freeport, said that unlike some of her competitors, she has always accepted Medicaid assignment even though it's a struggle to get reimbursed for large ticket items like scooters. She has to keep the cash flowing even as she wonders when she'll be paid for some items. Turning away patients demonstrates the problem.
"We just can't do it right now," said Sluiter. "I'm waiting to see how these (pending claims) turn out."
With the nearest Medicaid provider 50 miles away, beneficiaries could experience access problems, she said.
"I think a lot of times they just do without the equipment," said Sluiter, who has waited as long as eight months to get reimbursed, and then sometimes, for only half of what she is owed.
Larry Goldfarb, owner of Reliable Medical Supplies, said part of the problem is that Medicaid's calendar often differs from providers.
"The last time I spoke to them, they said from the date they receive the claim until they issue an approval, it's 80 days," said Goldfarb.
But while providers start counting the days from the date on which they submit a claim, Medicaid puts its own date on it, usually after they've had it a while, said Kirk.