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Medicaid Billing Glitch Costing Hillsborough Provider

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By LINDSAY PETERSON | The Tampa Tribune

Published: January 15, 2009

TAMPA - Problems erupted with the state's new Medicaid payment system the day it went online seven months ago. And they're still happening.

The Hillsborough Achievement and Resource Center, has lost about $12,000 in the past month because of a computer glitch that prevents it from billing for services at their full rate. The center provides day training and residential services for people with mental retardation, autism and other developmental disabilities.

HARC isn't the only one having problems. Since July, the state Agency for Health Care Administration has provided nearly $500 million in emergency reimbursements to nursing homes, home health agencies and other providers who couldn't get their claims through the new computer system.

The state hired Electronic Data Systems, of Plano, Texas, more than three years ago, agreeing to pay the company more than $300 million to develop and maintain the new system for the state's $15 billion Medicaid program. Medicaid is the government health care program for the poor and disabled.

The billing problems were heaviest in the weeks after the new system began operating, in June, said Agency for Health Care Administration spokesman Fernando Senra. But even now, the state is sending out 2 to 12 emergency payments per week, he said.

HARC's early problems have been resolved, but a new one cropped up about a month ago, said assistant controller Shirley Burdett.

When she tries to bill for a service that costs $1.48 per quarter hour, for instance, she gets an error code until she revises the form to request the next lower cost, $1.16.

Some claims go through at the correct rate. Some don't. "There doesn't seem to be any rhyme or reason to it," Burdett said.

She double checked her payment data to make sure she was using the correct rates. She e-mailed the state and the company that operates the system, Electronic Data Systems. And she called the system's help line, suggesting after the 10th or 11th call that it change its name, "because they are no help at all."

Still, the problem continued.

Last week, an EDS representative, Amber Ward, told Burdette by e-mail that other providers were having the same problem. Ward said it was "in the research phase at this time and people in Tallahassee are determining the issue. It is now on our known issues list."

Problems with the new system began the day it went into operation. Providers described a variety of complications. When submitting a claim, for instance, many were told they didn't have billing authorization or their client wasn't eligible for Medicaid.

The health care administration said the system was working well for most providers. For the dozens having problems, it provided emergency payments until the problems could be solved.

The continuing problems are part of breaking-in a new system, and EDS is dealing with them as they are reported, Senra said.

Meanwhile at HARC, "knowing the fix is on the "to do" list does not by any stretch of the imagination resolve the problem," HARC chief financial officer Frank Pannullo wrote in a recent e-mail to Ward.

"Our clients need our services whether we get paid or not," he said. "Every dime counts."

Reporter Lindsay Peterson can be reached at lpeterson@tampatrib.com or (813) 259-7834.

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