Officials from Lawrence Memorial Hospital returned Friday to the Statehouse armed with details about ongoing problems they’re having with the companies that manage KanCare, the state’s privatized Medicaid program.
In late December, the LMH officials outlined their concerns about payment and billing problems to members of the legislative committee charged with overseeing KanCare. In Friday’s testimony, Susan Thomas, the hospital’s director of compliance management, provided committee members with detailed accounts of billing disputes that she said illustrate systemic problems that aren’t unique to LMH.
She said it frequently takes months longer than it should to resolve disputes with KanCare’s three managed care organizations.
“It’s exhausting,” Thomas said.
“We deal with three different payers and there’s three different sets of policies,” she said. “There’s three different sets of denial reasons. There’s three different sets of process rules. And often there’s three different responses to similar issues.”
Confusing codes used by the MCOs when denying claims are a big part of the problem, Thomas said. She described the case of a toddler brought to the hospital’s emergency room by his parents with something stuck in his nose. The child was promptly treated and sent home, and the hospital submitted a claim to Amerigroup, one of the KanCare MCOs.
A week later, Amerigroup denied the hospital’s claim for reasons that Thomas said "no one understood," but agreed to pay the treating physician, who worked for LMH. The hospital appealed the denial and eventually got paid $173.50, but it took 51 days.
Other disputes cited in the hospital’s testimony took hundreds of days to resolve. One took more than a year.
Representatives of the MCOs said they are working with LMH to resolve the problems, which they assured the committee weren’t as pronounced at other hospitals.
“We are certainly very interested in improving the relationships that we have with our hospital partners,” said Laura Hopkins, chief executive of Amerigroup.
Hopkins said Amerigroup officials are meeting regularly with key staff at LMH and other hospitals to “improve our level of service to them.”
Several Republican members of the oversight committee said the processing problems described by Thomas are an unfortunate but unavoidable part of the health care system.
“It’s not unique to Medicaid, it’s across the spectrum,” said Sen. Jim Denning, an Overland Park Republican. “I feel your pain, but it’s everywhere. Just pick an insurance company.”
Rep. Willie Dove, a Bonner Springs Republican, said while KanCare may be more complicated, it’s better than the state-run system it replaced because claims are more closely scrutinized.
“Claims were paid with a lot less looking into,” Dove said of the old system. “That’s one of the reasons KanCare was implemented.”
The LMH officials disputed Dove’s claim of greater accountability, saying the state-run Medicaid program had sufficient checks and balances.
Democrats on the committee also pushed back, saying they believed that the KanCare MCOs can do a better job of processing and paying provider claims.
Rep. Barbara Ballard, a Lawrence Democrat, recalled the promise of improved efficiency was one of the reasons Republican Gov. Sam Brownback gave for privatizing Medicaid in 2013.
“I remember the conversation went something like, ‘It will be more efficient, it will be more effective,’” Ballard said.
Skeptical of that and other claims, Ballard opposed the change. But now, she said, “I just want to see it work.”