Colorado Medicaid contractor stops attempting to recoup funds to psychological well being suppliers

Colorado psychological well being therapists will not should pay again cash they acquired for seeing Medicaid sufferers after a state contractor that had threatened to “recoup” the funds reversed course Wednesday. 

Psychological well being counselors at practices in eight Entrance Vary counties acquired emails from Colorado Neighborhood Well being Alliance — the contractor that processes their Medicaid claims — notifying them it was “stopping the present recoupment venture.” This comes after the well being alliance despatched letters asking therapists to return 1000’s of {dollars} in funds that they had already acquired, a monetary debacle blamed on a software program error.  

This week’s reversal by the state contractor got here after studies in The Colorado Solar and 9News exposing the claims fiasco. A number of psychological well being counselors and therapists working in small group practices instructed The Solar they might not settle for Medicaid sufferers due to the paperwork headache and the newest struggle with the state contractor. 

For some, the reversal is simply too little, too late.

Carla D’Agostino-Vigil, one of many solely specialists in obsessive-compulsive dysfunction who accepted Medicaid in Colorado, was amongst those that determined she would not see Medicaid sufferers due to the newest trouble. Whereas she welcomed the well being alliance’s announcement, D’Agostino-Vigil mentioned Wednesday she had no plans to alter her thoughts about accepting Medicaid shoppers. 

“I’m cautiously optimistic this can end in a well timed correction,” mentioned D’Agostino-Vigil, who runs Ignite Counseling in Westminster. 

The licensed counselor already was affected by a 20% charge reduce for Medicaid sufferers that the well being alliance put in place in January 2020. And D’Agostino-Vigil remains to be within the midst of an unrelated dispute with the well being alliance over claims that have been denied attributable to an alliance software program concern, she mentioned. 

Therapists who already paid a recoupment price to the well being alliance will get a refund, the alliance mentioned.

The recoupment letters, copies of which have been reviewed by The Solar, instructed suppliers that they had 60 days to return the cash or Colorado Neighborhood Well being Alliance might withhold future funds. The well being alliance, which is owned by insurance coverage big Anthem, is actually the center man between the suppliers and the state Medicaid division and is chargeable for processing claims and dishing out cost. 

The therapists weren’t overpaid — they have been requested to return cash for providers they offered throughout prior years as a result of claims have been lacking a supplier identification quantity. 

Psychological well being professionals mentioned they included the supplier identification quantity on their claims. It was the pc system utilized by the well being alliance that scrubbed the identification numbers — required by state and federal legislation — from its claims. The contractor realized the error in July 2019 and glued its software program system in October 2020, mentioned spokeswoman Colleen Daywalt. Psychological well being suppliers have been warned of the problem through e-mail and in conferences since March 2020, however many mentioned they have been caught off guard after they acquired the recoupment notifications requesting cost this fall. 

Colorado Neighborhood Well being Alliance is the payer for 1,175 behavioral well being suppliers in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller counties. About 200 suppliers who didn’t resubmit claims acquired the recoupment letters, which requested for quantities as much as $18,000.

The well being alliance mentioned Wednesday that it was taking again the recoupment motion “in mild of current suggestions from behavioral well being practices.” 

As a substitute of requiring therapists to pay up or resubmit claims, the well being alliance is planning to contact every counseling apply to retrieve the wanted supplier identification numbers, Daywalt mentioned in an e-mail to The Solar. “We plan to work with suppliers to gather the info to make sure we’ve correct documentation with out requiring the suppliers to resubmit the claims,” she mentioned. 

She mentioned the alliance is “devoted to making sure entry” to psychological well being care in Colorado, noting there are actually 3,514 practitioners within the community.

The billing concern comes as Colorado has tried to broaden the variety of psychological well being professionals who settle for Medicaid, a authorities insurance coverage program for low-income residents and people with disabilities. The Colorado Division of Well being Care Coverage and Financing, which runs the Medicaid program and contracts with the well being alliance to disperse funds to the suppliers, mentioned the variety of suppliers statewide taking Medicaid reached 8,371 in June, in contrast with 6,029 in April 2020.

The division mentioned Wednesday that it was happy the state and its contractor “recognized a neater approach” to gather the required declare data. The method “was by no means supposed to be about recouping funds from suppliers however reasonably to have correct and compliant claims,” division spokesman Marc Williams mentioned in an e-mail to The Solar.

“Whereas 84% of suppliers have been capable of adjust to the declare information request through the 20-plus months of time offered, we perceive that this concern introduced a heavier administrative burden for the rest of the suppliers.”

Williams added that the decision “allows all our behavioral well being suppliers to proceed to ship care to our Medicaid members — particularly throughout this time of elevated demand for such providers as a result of impacts of COVID-19.”

Christia Younger, a Brighton therapist who acquired a recoupment discover for $7,200, was skeptical that the announcement meant issues with the alliance would enhance. 

“It’s excellent news, however I already paid an legal professional, drafted a letter, and spent a big chunk of my time faxing them all the corrected claims,” mentioned Younger, who sees sufferers with power suicidal ideas at Badass Remedy. “It additionally doesn’t repair all the different points suppliers have with them. I already had so many points with billing previous to this.”

Younger has stopped taking Medicaid sufferers by means of the well being alliance. 

“My Medicaid shoppers are a few of my favorites to work with,” she mentioned. “It has been heartbreaking to should prioritize my psychological well being and monetary well-being as a result of it’s so troublesome to work with Medicaid.” 

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