Eagle editorial: KanCare providers get squeezed

Is this how privatization of Medicaid saves the state money?
Is this how privatization of Medicaid saves the state money?

Delayed and denied payments from KanCare’s private insurance companies have gotten so bad that some service providers aren’t accepting Medicaid patients from certain companies.

Is this how privatization saves the state money? Is this what the providers of long-term care to Kansans with intellectual and developmental disabilities have to look forward to, now that the state has received federal approval to include these services in KanCare?

Deb Voth, president of Rainbows United in Wichita, told The Eagle editorial board that 90 percent of her agency’s billings to one of the managed-care organizations has not been paid. As a result, it is not accepting any more patients through that MCO.

Overall, nearly 50 percent of Rainbows’ billings to the three MCOs is in arrears, Voth said – and that is after Rainbows had an attorney shake some payments from the companies.

The Hutchinson Clinic sent a letter to its Medicaid patients last month telling them it might drop its contracts with two of the MCOs because of payments problems. Michael Harms, the clinic’s chief financial officer, told the Kansas Health Institute News Service that the clinic has had problems with “thousands of claims” and is behind “hundreds of thousands” of dollars in payments.

Though they haven’t dropped their contracts, other hospitals and clinics throughout the state also are frustrated with payment delays. Unpaid claims of 90 days or more at Wesley Medical Center and Via Christi Health in Wichita are double what they were prior to privatization.

Denied claims are also an issue. Between January and November 2013, more than 2.2 million KanCare claims were denied – about 16 percent of all claims. Wesley had more than $3.7 million in denied claims last year.

The delays and denials have been particularly hard on smaller providers, which have limited financial or legal resources.

Carrie Barker, who owns A 2 Z Helping Hands – a home health company with offices in Derby and Arkansas City – told The Eagle that she hasn’t received about $50,000 in reimbursements from the three MCOs.

“I feel like they’re trying to run us out of business, but they’ll still get their money (from the state),” she said.

Bureaucratic hassles also have increased the administrative costs of providers. Wesley had to hire additional staff to manage billing issues. Rainbows paid more than $15,000 in legal fees to negotiate autism contracts with the MCOs.

The state withheld 3 percent of its payments to the MCOs last year as an incentive to meet certain performance requirements, such as prompt processing of claims. State officials say they won’t know until early spring whether the companies will receive their 3 percent withholdings.

But even if it keeps all or part of those withholdings, that won’t help the hospitals and clinics still waiting to get paid.

For the editorial board, Phillip Brownlee