This development means that new All Kids clients won’t be getting any appointments at two of the best hospitals in the Midwest.
Pediatricians at a nationally recognized children’s hospital in St. Louis will schedule young Medicaid patients from Illinois “in the last available appointment” beginning Friday because the state is six months behind in making payments.
However, a spokeswoman for the Illinois Department of Healthcare and Family Services said that under a new policy, all doctors who treat Medicaid patients “will now receive payment for their services in no more than 60 days from the time bills are received by the state.”
The chairman and vice chairman of the pediatrics department of the School of Medicine at Washington University in St. Louis sent a letter to referring physicians that detailed the plan to delay appointments for new Illinois Medicaid patients. The medical school’s doctors are the exclusive staff for St. Louis Children’s Hospital, as well as for Barnes-Jewish Hospital in St. Louis. […]
“Currently, Illinois Medicaid physician reimbursement does not cover costs,” the letter states. “In addition, (the Illinois Department of Healthcare and Family Services) has not reimbursed any physician in the Department of Pediatrics in more than 200 days.” […]
An e-mailed statement from the medical school Wednesday said, “Unfortunately, over the last two years we have seen the lag time in reimbursement from Illinois Medicaid grow past 150 days, past 175 days, and after exceeding 200 days for several months, the lag time is currently at about 180 days.
“By contrast,” the statement continued, “Missouri Medicaid reimburses us on average in about 34 days, and Medicare reimburses us in about 25 days.”
UPDATE: The governor’s office responds. Via e-mail from a spokesperson:
First of all, this provider is NOT 200 days behind in getting paid.
They are being paid within 60 days if they’re docs covering adults and paid within 30 days if they treat kids. Here’s the problem with the situation laid out by the provider in today’s story: they’re counting Medicaid claims that are in DISPUTE with HFS — claims that have actually been PAID, but the provider feels that we didn’t pay them enough for the service they provided. So, this 200 day backlog in bills they’re claiming does not represent bills that are sitting at HFS going unpaid. They are claims already paid, but are in dispute because the provider wants us to pay more for the services they provided.
HFS has to follow federal guidelines to a “t” when processing claims for federal reimbursement. Every provider must demonstrate and document that the claims they’re submitting for reimbursement are medicaid-eligible. HFS will only reimburse for what is discerned as Medicaid-eligible services. Any provider can dispute claims that were rejected for reimbursement by HFS, but for the provider to characterize this situation as HFS being “behind” in making payments is very misleading. And, this group has been paid $2.7 million since the beginning of the current fiscal year.
HFS discovered what the specific situation was only after the SJR filed their story. Otherwise, HFS would have taken pains to describe the facts.