COLUMBUS, Ohio – Some independent home-health aides have experienced a delay in getting paid under an Ohio plan to coordinate care for the state's sickest and most expensive residents, though the state says certain providers have had issues or made mistakes in submitting claims.
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The workers perform health care services for Ohioans enrolled in both Medicaid and Medicare. The two government programs operate fairly independently of each other, and the project seeks to streamline how health care is delivered to more than 100,000 so-called "dual eligible" individuals.
The federal Medicare program serves the elderly and disabled. Medicaid provides coverage for the poor through state and federal funding.
Independent workers and home-health agencies previously submitted claims to the state government, sometimes through a billing agent. Now, claims go to five private insurance companies.
The Columbus Dispatch reports the change has created a problem in getting payment quickly to some workers.
Joanie Hoffman, an independent home-health provider, told the newspaper she used to be paid weekly but hasn't been getting paychecks regularly since July 1.
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"I put everything on the credit card that could possibly go on the credit card," she said. "I'm going to be backtracking for a while."
Sam Rossi, an Ohio Medicaid spokesman, said the project is meeting or exceeding federal prompt-pay requirements on properly submitted claims. Federal law requires that 90 percent of all claims have to be paid within 30 days, and 99 percent within 90 days.
The state says independent, home-health providers have faced more challenges converting to private health insurance billing standards than others, because many relied on third-party billing agents to submit claims. The managed-care plans allow all providers to submit claims directly.
Rossi said insurance companies have provided ongoing training to ensure that providers know how to correctly submit claims.
"There is a learning curve here that we are seeing," Rossi told The Associated Press.
Ohio Medicaid director John McCarthy said more independent providers than home-health agencies have notified the state of billing issues.
But, he said, "If there has been a problem with an agency, the plans have been working those out very very quickly, in some cases advancing them money to ensure that people can get paid and working through those issues."
McCarthy said the same holds true for independent workers. The advance is then reconciled later on when the health care plans can process the correct claims.
Aetna spokesman Rohan Hutchings told The Dispatch that the company is calling providers and answering questions.
"In some cases, we've even hand-delivered checks," Hutchings said. "That's what we've been doing to get the money out the door."
Amy Clubbs, Molina's Ohio president, told the newspaper that the company's turnaround for all types of claims averaged 6.2 days from January through June.
Information from: The Columbus Dispatch, http://www.dispatch.com