“No Kids,” and nobody else, either - UPDATED x1
Thursday, Aug 31, 2006 - Posted by Rich Miller
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.
- JS in Chicago - Thursday, Aug 31, 06 @ 2:16 pm:
Thought that Blago cared so much about the kids of this state…we will now see a new policy adopted for payment soon when kids are involved as it takes threats like this to get the administrations attention. Sad for the kids but this one falls right on BLAGO!
- Capt. Caveman - Thursday, Aug 31, 06 @ 2:23 pm:
This will add to the problems the citizens of southern Illinois face when looking for medical care. The shortage of doctors, especially in ortho and neuro, have caused patients to travel to St. Louis for treatment. Where do they go now?
- sam - Thursday, Aug 31, 06 @ 2:26 pm:
seems like they just want to make sure the payments will get there in 60 days. An up-front threat.
- Oh? - Thursday, Aug 31, 06 @ 2:33 pm:
How ambiguous is the criteria for claims in dispute or for “problems” with Medicaid billings by healthcare providers?
- Yellow Dog Democrat - Thursday, Aug 31, 06 @ 2:34 pm:
So, if the department just wants to sit on the money, they do what HMO’s do. They just refuse to pay the full claim, and force providers to fight for the money they’re owed, while patients are left hanging.
Makes sense to me. The world needs more HMO’s.
- Anon - Thursday, Aug 31, 06 @ 3:07 pm:
Hmmmm . . . who should i believe? A world reknown research hospital known for its great care and community involvement . . . or . . .
the biggest pay to play governor in the country, who will likely be indicted within 2 years . . .
hmmmmm . . . I wonder who is telling the truth?
- Downtown - Thursday, Aug 31, 06 @ 3:10 pm:
What on earth is “the latest available appointment?” A week from never?
This sounds like a law suit, just waiting to happen.
- Anon - Thursday, Aug 31, 06 @ 3:30 pm:
the latest available appointment means that patients under All Kids will be given no preferential treatment if someone with coverage that pays needs an appointment on the same day…
if basically means that they would be scheduled as tentative appointments that could be replaced by people with coverage that gets paid. It is a very legal practice…
- Bubs - Thursday, Aug 31, 06 @ 3:34 pm:
I believe the doctors. These days, if a “Spokesman for the Blagojevich Administration” said that 2 + 2 = 4, I would break out a pocket calculator and check it out.
- chinman - Thursday, Aug 31, 06 @ 4:01 pm:
Rich,
I think john/ken lay and stevie/abrasive math wiz wore off on you over the last couple days. 14 threads in one day has to be some kind of record.
- Medicaid Payments Illinois Style - Thursday, Aug 31, 06 @ 4:09 pm:
These respected research hospitals are well within their legal rights to schedule these appointments in this manner. They are not legally bound to subsidize Illinois’ lax payment policies.
This current administration has a long history of payment neglect; as a matter of fact they have just recently admitted that they don’t even check to see if the people getting served through Medicaid are in fact even eligible to receive those benefits.
Now from an administration that is not even checking Medicaid eligibility we are to believe that it’s the respected institutions that are at fault not this governor. Who lacks the real credibility here? It won’t be the governor who suffers from this but the very people that need these services. Once again in actual practice he turns his back on those he purports to care so much for during his campaign commercials.
- Anonymous - Thursday, Aug 31, 06 @ 4:15 pm:
The HFS explanation is very plausible. Especially with out of state providers, they send in a claim on anybody who is from Illinois and poor and expect HFS to sort out who is eligible. They bill at their customary rates, without regard to what Medicaid pays. Now that you’ve heard HFS’s side of things, it would seem that the St. Louis providers should either dispute it - no, we haven’t been paid - or acknowledge that they basically misled the press to get leverage on the State of Illinois to pay them for ineligibles or excessive rates. Until they do, I don’t think you should just assume that a “great” hospital/provider system isn’t capable of puffing. Some of the best systems in the country have been convicted of fraudulent billing.
- Medicaid Payments Illinois Style - Thursday, Aug 31, 06 @ 4:27 pm:
In fact maybe its the governor’s administration that should have to prove it is paying on a timely basis given their past history of not having done so instead of just issuing a press release. Especially give the fact this governor has time and again issued press releases but has failed to back it up with facts or action.
- VanillaMan - Thursday, Aug 31, 06 @ 4:39 pm:
The Democrats have been trying to sell us a pipe dream that they will take care of our health care needs. This report is the reality. What is happening in St. Louis is happening in every country with universal “health care”.
Not only are kids not covered when they need it or health care providers not paid when they need it, but the situation WILL GET WORST. As our population ages, the demands will increase, the costs will skyrocket, and our state will continue to seek funds to pay it’s growing budget deficits at our expense.
But HEY, the “care” that is given is free isn’t it? Who says it had to be good or timely? Take a look at what YDD wrote, (whom is a poster I respect), and you will see him already backpedalling away from the promises given by the state Democrats. HMOs do it - so?
Hey YDD, prepare yourself when the services get worst than HMOs. What will be your next excuse? Heres a couple: In Germany, they’ll tell you that you don’t need to worry about the surgeries you can’t wait for, and then give you snake oil pills because real pills cost them too much. In Canada, they go to the US for those surgeries. In England, they go to private hospitals. Nearly every smart doctor in India comes here to work.
Folks, if everyone else in the world is coming here for expert medical help or depending on our free market to pay off their medicine’s research expenses, what will happen when we have government do it? Without a competative market, no more cutting edge drugs without government approval, and everyone waits for that free health care.
I read so many bloggers dissing Roskam’s proposals, but at least he’s not trying to blow smoke up your hospital gown with promises that cannot be kept. It is time that voters get off the dream that they can get what they want, when they want it, and at someone else’s expense.
- Squideshi - Thursday, Aug 31, 06 @ 4:41 pm:
Pardon the expression, but the Governor’s spokesperson is full of baloney. This is, indeed, one of the ways that Blagojevich is “balancing” the state budget. Here’s another: Blagojevich signed into law the so-called Children’s Mental Health Act of 2003 (Public Act 93-0495) adding an additional layer of screening and assessment, with the intention of forcing children into less expensive outpatient programs. In addition to the already rigorous Screening and Assessment Services (SASS) and Utilization Review process (provided via contract by Healthsystems of Illinois) they added something called the CARES Line, to act as a gatekeeper. Mental health providers are afraid to make a big stink, because they’re afraid that they’ll get targeted and reimbursement will suffer; but many believe that the staff at the CARES Line (also contracted) intentionally make it difficult to get a child admitted. If you look at the numbers, you can easily see that inpatient adolescent psychiatric services utilization dramatically decreased following the passage of this act. Good work Blagojevich, reduce cost by creating more red tape and denying kids the healthcare they need!
Also, if you want to know how slow the state pays, ask ANY Business Office Manager at ANY for-profit hospital in the state of Illinois. This is exactly why so many factor, or take out loans against, their accounts receivable–they need to pay the bills somehow!
- Budget Watcher - Thursday, Aug 31, 06 @ 5:39 pm:
If the payment cycle is as good as HFS indicates, then why the new policy from this pediatric group? Does Wash U. have a political agenda? Is that what HFS is implying?
It’s not great policy to call your provider groups liars, especially when you’re trying to entice them to serve new coverage groups.
- annon. - Thursday, Aug 31, 06 @ 5:53 pm:
Wat to go Bladgo !!! Instead of cooking up new schemes & programs we can’t pay for….PAY SOME OBLIGATIONS ALREADY FACING THIS STATE !!!!!!!!!!
- Little Egypt - Thursday, Aug 31, 06 @ 8:52 pm:
I wouldn’t believe this GoverNOT if his tongue came notarized. Same for all of his spokespeople.
- schroedk - Thursday, Aug 31, 06 @ 9:23 pm:
It’s easy for me to believe St. Louis Children’s and Barnes in this case, because what we encountered at my wife’s medical clinic and what is “reported” to be the facts by this administration are very similar in tone.
I’ve stated on here before that my wife, a family practice physician, was essentially forced to abandon her private practice and join Quincy Medical Group because of late and insufficient payments by the state. Here are a couple anecdotes for everyone to consider.
1) We had an established Rural Health Care Clinic. In order to attain this status, certain criteria must be met, including total population per provider as well as poverty levels (i.e. a high percentage of medicaid recipients). Yet the state has claimed in press releases that clinics in which a majority of the patients treated are medicaid recipients are paid on a faster cycle, I believe either 30 days or 50 days. However, we were routinely seeing 180 day delays in payment. The state then claimed that if we could “prove” that a majority of our patients were medicaid they would pay us faster. We had essentially established that proof when our clinic attained Rural Health Clinic status. Regardless, there was no increase in reimbursement speed.
2) During the months of May and June of this year, our former office manager was calling HFS daily to push for reimbursement. We are still waiting for payment (first payment, not disputed) for patients seen 12-15 months ago. There is a doctor still attempting to practice in our former clinic who was facing delayed payment of about 200 days and well over 5000 claims. During one phone call, the office manager was told (this is second hand from her) that “if the clinic needed to borrow the money, they could borrow from the state at only 4% interest, which is better than the 8% interest that a bank would charge”. Um, excuse me, but if the state has money to “loan” to health care providers, how about trying a novel idea and pay the bills. It sounds like extortion and/or a forced 4% paycut to me. If a spokesman were to tell me that bills are paid in order of receipt, I would laugh in their face. I have no doubt in my mind with all the games the state plays that those desperate enough to take the “loan” were moved on up to the head of the line, and those who refused sent to the back.
I think the primary issue is not that this late payment is necessarily new (it’s been getting progressively worse over the past four years, but existed before then), but it’s that knowledge of it is becoming more widely realized. It’s been spoken of within health care circles for at least 3 years, and I’ve seen a few newspaper articles regarding late payments. However, just as with almost any crisis in history, notice isn’t really paid unless it directly affects “me”, which is what we’re seeing.
- zatoichi - Thursday, Aug 31, 06 @ 9:27 pm:
So the issue is The Gov wants new programs for children because they deserve them. However they do not want to pay the real cost of services (call it a deep, payor determined discount) and don’t feel the need/are unable to pay their bills within a reasonable time frame. Why would any medical provider want to work like that? This is a surprise?
- Anonymous - Thursday, Aug 31, 06 @ 10:14 pm:
Rich,
Why no post/open thread on the Dorthy Brown announcement?
- pfk - Thursday, Aug 31, 06 @ 10:21 pm:
Maybe because Dorothy Brown is not really out to win…just out to deter JJJ from running.
- Disgusted - Thursday, Aug 31, 06 @ 10:53 pm:
There is proof that the administration is lying. About two weeks ago, a state printshop was printing a letter to go to doctors, telling them that their Medicaid payments would be paid in 60 days if they would agree to support AllKids. This is tantemount to an admission that they are past due and that physicians won’t take the new insurance.
Add to that the fact that 95% of the literature put out on AllKids to applicants does not state that your child has to be without insurance FOR ONE YEAR before they can become eligible for service. It does appear on the application but not on most advertising.
Further add to that the push to get mailings of hundreds of thousands of pieces of advertising for AllKids, Senior Care, Vet Care, SaveRx, etc. in the last couple of months and you can see where this is going. A campaign run on printed materials and mailings paid for by the taxpayer with no regard for the cost of such mailings or for the other print work piling up in state-wide printshops while the governor feeds his publicity habit.
- Truth - Thursday, Aug 31, 06 @ 11:32 pm:
Everyone on this blog knows who’s telling the truth here. Ask any provider if they’re getting paid and they will ALL tell you the same thing. Go ahead and call your providers liars, but we all know the truth. This program is royally screwed up. Kids aren’t getting healthcare because we’re not paying our bills. Healthcare Governor? Not even close.
- El Conquistador - Friday, Sep 1, 06 @ 12:40 am:
This is just sad… Who would re-elect this guy?
- leigh - Friday, Sep 1, 06 @ 6:58 am:
I have a niece in Southern Illinois with serious heart problems. As with all children of Southern Illinois (south of Effingham, not I-80) she must go to St. Louis to be treated. I wasn’t a fan of the gov’s before, but now it is personal. The man needs to stop running for governor and start governing!
- Shallow Pharnyx - Friday, Sep 1, 06 @ 7:44 am:
Bubs & Little Egypt (does that mean Cairo?)-
You crack me up and you hit the nail on the head!
- Just Wonderin' - Friday, Sep 1, 06 @ 7:45 am:
I believe that the Medical school issued a statement Thursday evening that said, “IF Illinois Medicaid denies a claim because the services are not covered under Medicaid guidelines, Washington University does NOT include that bill in its calculation of days of revenue outstanding. We use standard accounting practices to calculate outstanding revenue.”
I wonder what standard practices GRod and HFS use?
- leigh - Friday, Sep 1, 06 @ 7:52 am:
Does anyone believe anything that comes out of the gov’s office anymore? Perhaps mommy and daddy should have taught them that lying is wrong.
- Team Sleep - Friday, Sep 1, 06 @ 8:34 am:
Always remember the basic tenet of government vs. private society: private services, thought and practices are always better and should always be trusted over bureaucrats. Sorry, DHS, DFCS, John Filan, et al; I will trust Barnes Jewish Hospital and MoBap before I trust you.
- zatoichi - Friday, Sep 1, 06 @ 8:40 am:
This may be a small point but the State response says the physicians are being paid within 30-60 days. Ok, just assume that is right. Is the hospital the physicians practice at the group that is 200 days behind in payment? Most physicians will be on staff at a hospital and some may hold paid positions with that hospital(usually some type of admin/director spot). However their physician professional services are billed and paid seperately from the the services provided by the hospital. The physicians and hospital will often work very closely and appear to be the same company even if they have no ownership in each other. The physicians will often speak up for the hospital where they have priviledges. This is especially true in specialties like Pediatrics. If the hospital cannot provide the specialized services needed (labs, radiology, surgery, therapy, etc), the specialist physician will have trouble getting treatment they want done and patients must be turned down. The office managers of the hospital and the physician practice are two entirely seperate groups who will have seperate collection outcomes.
- Guy Fawkes - Friday, Sep 1, 06 @ 9:36 am:
Blago mouthpieces are lairs!
- Cassandra - Friday, Sep 1, 06 @ 9:44 am:
Adolescent in patient psychiatric care is easily abused and often unnecessary if the patient receives competent psychiatric treatment. Inpatient psych units are not supposed to be boarding houses for unruly teens. The inpatient care is also extremely expensive.
So it makes a lot of sense, for the patients and the taxpayers, for very close screening of adolescent inpatient admissions to psych facilities.
The Blago administration deserves credit, from both a clinical and a financial standpoint, for
upgrading the screening of these admissions if such is the case.
- just guessing - Friday, Sep 1, 06 @ 10:33 am:
I’m just glad to know that unlike Missouri, Illinois is following the federal laws to the letter and not paying the two St. Louis hospitals whatever they want. After all, the fact that Missouri’s payment cycle is less than 40 days can only be explained by either ignoring the federal laws to the “t” or that these giant organizations have seperate billing, one for Illinois and one for Missouri, one filled with overcharges to defraud the public (requiring Blago et.al. to underpay and create disputes), the other filled with scaled back charges to fit the Missouri medicaid rules. What a bunch of crap! We delayed the billing cycle to balance the budget, and now that this mandated loan from vendors is causing a political storm based on access, the Gov. falls back on his tried and true, “Its their fault!” defense. Sady, predictable, and possibly continuing for four more years…
- FORMER STATE EMPLOYEE - Friday, Sep 1, 06 @ 10:48 am:
Boo Hoo, Blago’s mouthpiece seems to take offense at the truth.
- Anon - Friday, Sep 1, 06 @ 11:31 am:
Today they are less than 60 days. 2 weeks ago it was over 200
- schroedk - Friday, Sep 1, 06 @ 11:38 am:
Gee, Anon at 11:31, I’m sure that has nothing to do with the fact that the state receives it’s large influx of federal money in July. The delays start getting longer and longer in, oh, around October.
- tidbit - Saturday, Sep 2, 06 @ 10:50 am:
Aside from the slow payment issues, has anyone ever stopped to actually look at the All Kids program? Why is it called “All Kids” when only “some kids” are covered? Don’t cancel your insurance just yet, because you can’t get coverage for a year if you do…unless you’re an undocumented alien. Yes, that’s right, any undocumented alien gets coverage basically without question while American citizens are denied. Let’s stop to look at this before we worry too much about the slow payment process. While I understand that without payments, most physician offices and clinics can suffer a serious financial crisis, we need to look at the entire scope of the issue. Illinois is hurting for money. That’s why all the deferrments in pension funding and medicaid payments,but at the same time, state employees are being told to do more with less. Less employees + more work = slower outcome. Come on, Governor Blagojevich, let’s get people working on the real issues like actually working for the people of this great state rather than a re-election campaign! If you want to impress us, take your name and picture off the All Kids program material, or at least reduce the sizing of your name to make the program name larger than yours. If this isn’t being used as a publicity stunt, why is your name on the application 8 times and in larger print than even the program name? Now there’s some points for all of you to ponder over the weekend. Have a safe and enjoyable holiday!