Starting July 1, NCTracks replaced a billing system originally built in the late 1970s that is supposed to handle Medicaid claims valued at $12 billion annually from more than 70,000 providers statewide. But it stumbled out of the gate, as routine invoices by doctors, dentists and hospitals were rejected and new billing terminology threw off their billing experts — even those trained to use the new program.
Frustrated medical practice administrators and a hospital executive also complained to lawmakers at the October oversight committee meeting about problems and long wait times at the call center operated by Computer Sciences Corp. Joe Cooper, the chief information officer at DHHS, said those problems have been fixed or are being addressed, while one-on-one line or in-person training by CSC are slowly helping providers understand how to file proper reimbursement requests. The call center is now answering "within seconds," he said.
"I feel more comfortable with NCTracks in the last 30 days," said Sen. Tommy Tucker, R-Union.
Some lawmakers still weren't happy with statistics offered by the agency that showed less than two-thirds of weekly claims by doctor's offices are actually getting approved. These rates and those for dental claims approvals are still below what the legacy system produced, and little changed compared to percentages provided to legislators in October.
"I may be missing something but I don't see the progress," said Sen. Martin Nesbitt, D-Buncombe. "From these numbers and what I'm hearing here today, I don't think we're fixing the problem."
Cooper said that 10 to 15 percent of the doctor's offices and other non-hospital medical providers are still having problems with the new identification numbers they've received and are needed for billing Medicaid.
"The only way we can deal with that is on a provider-to-provider basis, and that's what we're doing," Cooper said during a break.
Fiscal analysts from the General Assembly's staff and Gov. Pat McCrory's budget office said Tuesday the slow accumulation of claims data and delays in NCTracks payments make it hard to project whether Medicaid is likely to run a shortfall this fiscal year. Access to additional data is expected in December.
There are also other unknowns, including how much Medicaid services will increase as more of the new federal health care overhaul law takes effect, the analysts said. This year's state budget appropriated nearly $3.5 billion for Medicaid, the federal-state health insurance program for 1.7 million mostly poor children, older adults and the disabled. The federal government pitches in nearly $10 billion more.
The five-hour meeting also included disagreement between the Fiscal Research Division and State Auditor Beth Wood over whether North Carolina's administrative costs for Medicaid were high or low compared to similarly-sized states. Administrative costs are important as McCrory's administration and the legislature debate how to bring Medicaid spending under control.
Wood released a performance audit in January that calculated North Carolina's administrative costs as the highest among peer states, citing federal Medicaid figures and auditor calculations. McCrory used that finding to lobby for moving Medicaid operations more toward the private sector.
But a report released Tuesday by the Fiscal Research found North Carolina's costs as among the lowest of those states. Steve Owen, the division report's author, told lawmakers his proposal also was based on a consultant's report and division interviews with Medicaid staff in other states.
Wood told the committee she stood behind the rankings in the performance audit, saying the consultant's report used unaudited and self-reported data from the state. She said the focus on administrative cost rankings cloud the report's purpose — to explain why the state continues to face sizeable Medicaid shortfalls.
