March 29, 2024
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Medicaid tops list of doctor obstacles Official: Payment system improving

BAR HARBOR – The state’s new computerized Medicaid bill-paying system is still in such disarray that some doctors and other providers have stopped accepting new Medicaid patients, while others have threatened to discharge the Medicaid patients they have.

But physicians attending this weekend’s 152nd annual meeting of the Maine Medical Association were told that the new system, which has been dysfunctional since it came on line in February, is on the mend.

John Michael Hall, deputy commissioner of the Department of Health and Human Services, told a conference room full of skeptical physicians Saturday that the amount paid to providers each week in interim payments – imprecise payments made in lieu of correctly processed claims – has declined each week and is down to about $5 million a week.

“That’s about 25 percent of total money paid out,” he said. “The other 80 percent are claims being processed correctly by the system.”

Hall, whose full-time job focus these days is on getting the billing system to work correctly, said he expects to be able to phase out the interim payments altogether over the next seven or eight weeks and to begin the complex task of reconciling the state’s Medicaid books with provider records by the late fall or early winter.

The Medicaid billing glitch was just one of several issues identified by Maine physicians Saturday as significant obstacles to maintaining their practices.

Others include high business taxes, low Medicaid and Medicare payments, inflexible mandates regulating handicapped accessibility, the state’s failure to enact medical liability reform and the need to hire pricey translators in some parts of the state where multiple languages are spoken.

Bangor neurologist Dr. Stephanie Lash said the combination of stressors makes it difficult to attract and retain new physicians. Her small practice has been trying to recruit doctors to replace two who are leaving, but the salary they’ll be offered will be only about half the national average – the same as she makes, she said.

More and more doctors are leaving private practice to become employees of hospitals, health centers or other facilities, Lash said. This allows them to be only indirectly affected by the hassles of billing and other business concerns, she said. “We’re all just playing this crazy game, trying to deal with this dysfunctional reimbursement system.”

Gov. John Baldacci spoke to the physician assembly in the late morning, touting his efforts to improve health care by combining the state’s Department of Human Services with its Department of Behavioral Health, and putting in a plug for his DirigoChoice health insurance program, now under scrutiny for funding difficulties. Improving health care is essential to building the state’s economy, he said.

The focus of this year’s MMA meeting was “Emerging Threats in Infectious Disease.” In addition to a full-day discussion Friday of a widely predicted influenza pandemic, participants were updated on the incidence and treatment of whooping cough, hepatitis C, tuberculosis and other highly contagious disorders.

During the business portion of the meeting, members voted to pass a number of resolutions, including making a contribution to relief efforts for victims of Hurricane Katrina.


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