Clinical Advisor, a Medicaid reimbursement computer program built by state contractor Magellan Health Services, is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It’s not working. As a result, providers — many of which ... serve Medicaid clients — haven’t been able to submit Medicaid claims. What’s more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid.But the problems with implementing the new system extend far beyond what the McNeils are facing, as evidenced by a report from The Advocate on a recent legislative hearing where state Department of Health and Hospitals Secretary Bruce Greenstein addressed tough questions from lawmakers who remain skeptical about the new plan:
Magellan is engineering and installing a massive database that will allow clinics to share information on treatment, patient prescriptions and medical history. While the state is paying the company per-patient fees for management services, individual providers get the software without charge.
Under the LBHP, he says, providers are no longer being paid for Medicaid claims for services provided over the phone. Some phone services, such as scheduling calls, were never covered ... Other phone services — such as calls to other clinics or to patients’ parole or probation officers — are now being handled by LBHP, and thus are not billable.
Having many previously billable claims denied under the new rules leaves clinics with several choices, none of them good. They can ask their staff members to work for free. They can refuse to take calls and risk possible malpractice charges. They can submit a claim for phone care as another, approved service — such as counseling — and possibly be charged with attempted fraud. Or they can pay for phone care out-of-pocket and cover those costs by cutting back elsewhere.
The state started phasing in the program in Livingston, Tangipahoa and the New Orleans area in February. Providers complained about having claims routinely rejected and long lag-times in payments on others. The complaints were mainly directed at what are known as “shared savings” plans operated by United Healthcare of Louisiana and Community Health Solutions of America.Read more here and here.
Greenstein said problems in getting physicians, hospitals and other providers paid in areas where the program started won’t delay the April 1 expansion of the Bayou Health program into the Baton Rouge and Acadiana areas.
Greenstein’s comments came during and after a House committee meeting at which state Rep. Katrina Jackson, D-Monroe, asked whether Greenstein would consider delaying further expansion of Bayou Health.
“Before this plan is implemented in a new area, we need to have a real discussion on where the (health) plans are,” Jackson said.
“When physicians don’t get paid, they don’t treat Medicaid patients. If this hits Baton Rouge ... and it’s still not worked out, it’s going to discourage physicians in my area from accepting Medicaid patients,” Jackson said.
MAY 22 This post was written the day after the second line shooting in NOLA, by Brentin Mock. Mock is a friend of Deb "Big Red" Cotton, a blogger who was shot in the back and was seriously injured. It is a raw, emotional piece of writing, something the writer obviously felt he needed to get off his chest. But it raises questions that can't be easily dismissed, and might give some insight into where the source of these events truly is.
MAY 22 In this Baton Rouge Business Report post, Rolfe McCollister considers the privatization of bus service in Baton Rouge. After decades of under-funding, it is a mess, and although a tax (partially) passed last year, improvement hasn't happened yet. McCollister apparently feels it is time to let private business get in on the transit business.
MAY 22 This post on Bayou Buzz by Jeff Crouere urges the defeat of a bill that would grant modest pay increases over the next several years to the state's judges and clerks of court. The state is in no position to fund pay hikes, Crouere argues, with the pay increases costing a total of $9 million over several years. It sends the wrong message to the (proverbial) hard-working people of Louisiana, he says.
MAY 22 The Advocate reports here that State Treasurer John Kennedy is complaining about a meeting of the corporation that oversees the state's tobacco settlement. The Governor wanted it restructured, and he has some support, but not a lot. The corporation agreed with his plan, but Kennedy didn't, and it appears that the meeting was noticed in a manner completely different than that of all previous meetings. Kennedy's given to hyperbole, but in this case the fish don't smell too fresh.
MAY 22 In this Advocate story, Carencro Police Chief Carlos Stout says the recent federal indictment of a strip club owner is all wrong. The indictment alleges that drugs and prostitution went on with impunity because club staff made arrangements with "local" police. Stout says it never happened, and while his cops do work security in the parking lot, they're not allowed inside.
MAY 22 This amusing post in DIG Baton Rouge recounts an ad that ran on Craig's List recently; the advertiser was seeking tenants for a Beauregard Town house. He knew his market, and wrote an ad that the most ironical hipster couldn't resist. Apparently, he really did know his market, because the ad worked like a charm.
MAY 22 In this post in The Lens, Mark Moseley comments on the rhetoric Gov. Jindal employed in trying to save his tax "reform" package. One interesting point concerns Jindal's use of his brother, Nikesh, in a little story. Nikesh left Louisiana because of his inability to get a decent job, the story goes, but the story won't hold water: Nikesh lives in DC, which has an income tax level comparable to Louisiana, Moseley says. If income taxes caused the dismal situation, it should exist in DC too. Right?
MAY 22 This post by columnist John Maginnis traces the trajectory of the bill that would fund construction at community and technical colleges -- and bypass the Board of Regents and traditional higher ed funding mechanisms. Sure, it will bust the legislature's self-imposed debt limit, but some leges feel that there's more need (because there is more growth) in the community and technical college area than in the university area, he says.
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