Medicaid seeks more money from county

By Andy Winemiller -

DOBSON — More Medicaid dollars will be delivered back to the state, though they are unrelated to a prior issue with Medicaid reimbursement.

On Oct. 17 the Surry County Board of Commissioners voted unanimously to send Medicaid funds back to the N.C. Department of Medical Assistance (DMA).

According to Finance Officer Sarah Bowen, the county owes DMA $40,184. DMA has reprocessed EMS claims filed during the time period of July 1, 2013 through Oct. 31, 2015.

Bowen told county commissioners Medicaid has opted to quit paying as a secondary payer to Medicare. The decision is retroactive to the July 2013 date, and DMA has begun the process of recouping the over-payments, and the department will also be recouping monies paid for services rendered at the Surry County Health and Nutrition Center.

In her written correspondence to the board, Bowen notes Vance and McDowell counties are going through the same process.

Bowen said she hopes the process of take-backs will soon come to an end.

Commissioner Van Tucker founded a home healthcare business based in Pilot Mountain. He said the take-backs, especially the most recent, aren’t surprising, as healthcare providers are always tangling with issues arising from billing Medicaid for services.

“You put together your best estimate of what you are billing,” explained Tucker. “Then they reserve the right to come back and tell you that you owe them.”

He said the rules are constantly changing, and Medicaid can even change the rules and apply them to past services for which a provider has already been reimbursed. That process often ends in a healthcare provider sending dollars back to the state.

Tucker said he didn’t want Surry County residents to get Oct. 17’s issue mixed up with EMS Medicaid take-backs which could result in more than $1 million being sent back to DMA. Those take-backs were a result of a miscalculation of the number of EMS transports. The $40,184 is the result of a retroactive change to Medicaid’s billing procedures.

“This is entirely the result of Medicaid changing the rules,” explained Tucker. “We are certainly not the first (healthcare provider) to pay back Medicaid.”

Tucker said the challenges are never ending when dealing with the “convoluted” Medicaid reimbursement methodology.

The other problem

Tucker then transitioned into discussing the billing issue which resulted in larger recoupements from EMS Medicaid billing, asking Bowen if steps had been taken to ensure that problem was fixed.

“We now have four sets of eyes looking at those reports prior to me looking at it,” answered Bowen.

In August, it came to the attention of county commissioners that Surry County owed $281,646 to DMA from overpayments in the 2011 fiscal year. More recoupements for subsequent years could result in a total of a little more than $1 million being sent back to the department.

That recoupement was the result of the number of EMS transports being improperly reported to DMA, but Tucker said he has heard many theories being tossed around between county residents.

“Let’s be clear,” said Tucker. “No money was ever stolen, and there was no calculated effort to be disingenuous.”

Tucker said he’s been hearing about a “theft that never happened” since the Medicaid debacle became public knowledge.

“The wrong formula was used (in calculating charges),” said Tucker. “It was never money we were supposed to have. It was a simple miscalculation.”

Bowen, who is relatively new to her position as finance officer, noted the issue arose from the county’s finance office reporting only the number of Medicare and Medicaid EMS transports to DMA when, in fact, all transports should have been reported.

Since DMA pays based on an average cost per transport, the improper reporting resulted in the state department overpaying for each Medicaid transport.

Tucker said he wanted it to be made clear in the most recent issue the county was not at fault. Instead, “It is simply a retroactive rule change.”

By Andy Winemiller

Andy is a staff writer and may be reached at 415-4698.

Andy is a staff writer and may be reached at 415-4698.

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