Providers of key child therapies in N.J. plagued by billing system problems

This article originally appeared on NJ Spotlight.

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Agencies that provide speech, physical and other therapies to tens of thousands of New Jersey children have struggled since November 2017 to get properly paid by the state, thanks to a troublesome billing system installed just before former Gov. Chris Christie left office.

The Murphy administration helped ease the pain starting in early 2018, agency leaders said, by meeting with stakeholders and fronting more than $44 million to help them pay salaries and other costs while the state addressed glitches in the new system.

In March, state officials sought to start recouping this money. But provider agencies — whose services support the state’s Early Intervention Program, designed to detect developmental difficulties in young children — said the repayment request is premature, given ongoing problems with the billing system. As of this spring, they said the system enables them to get paid on roughly three out of four claims.

“We knew this (billing system) was going to be a catastrophe,” said Dan Keating, executive director of the Alliance for the Betterment of Citizens with Disabilities, whose members provide speech, physical and occupational therapy and other services to the children flagged for extra help through the EIP. The system was implemented with little warning or provider input and no agency testing, he told the Assembly Health Committee last Monday.

The advanced funding “has saved many of the providers,” Keating added. “But it’s tough to pay back what you don’t have.” While the agencies accept they may have to refund some of the money, they want the state to clear all the back claims before they are forced to settle up, he and others said.

Lawmakers weigh in

Several Democratic lawmakers have also weighed in with legislation that would require the state Department of Health, which oversees the EIP, to process all the backlogged and current bills before forcing providers to repay any funds. The bill — which the health committee approved unanimously Monday — also calls for the state to issue agencies annual statements to show what providers were paid, versus their claims and set up a process for them to appeal these decisions.

The DOH said the new system — designed to centralize billing, management and other early intervention services — has been able to process all claims properly since June 2018. The billing delays agencies experienced were largely related to old claims for children that were managed through the previous system and were not automatically transferred during the switch, spokeswoman Dawn Thomas said.

To help with this transition, in March 2018 the DOH began a series of payments to 38 agencies that totaled $44.13 million by November that year, Thomas said; funding allotments were based on claims activity over the previous two years. “The advance payments were provided to the providers to ensure that they would have the financial resources available to operate while the claiming issues were resolved,” she said.

The department also hosted three webinars and held calls and meetings with individual agencies to explain the process — and the fact that the money would need to be repaid by the end of 2019 to meet federal Medicaid requirements, Thomas noted.

Regardless of any dispute, both the DOH and agency leaders agreed the issue has not impacted the care provided; Thomas thanked the agencies for their commitment to the children involved. “Not one child has not received services,” Keating said Monday.

New Jersey’s EIP was founded decades ago and is considered quite robust, with hundreds of millions of state and federal dollars that pay for state oversight, provider contracts, and agreements with scores of regional, county and local organizations that help to screen, diagnose and treat children for a range of developmental disabilities, including autism.

Thousands of children receive treatment

Nearly 14,000 youngsters are receiving treatment at any time, and 27,000 New Jersey families benefited from the system last year, Thomas said. The goal is to identify an issue early so children can be treated as soon as possible — while their brain is still developing — and before problems become more severe and harder to address, experts said.

In early 2017, the state hired Public Consulting Group to develop and implement a centralized web-based system for agency billing and management and family portals; it was designed to provide real-time payment to the providers, Thomas said. But Keating and others said this was done without consulting the agencies involved, proper testing, or a backup system to catch any errors.

When the system went live in mid-November 2017, agency leaders said problems arose immediately. Children and families already receiving services didn’t show up in the new database, recent claims couldn’t be entered properly, and both the billing and payment process stalled. By March 2018, Keating said his members were getting properly paid for about half of their claims.

“It’s all incumbent on a billing system that works,” said Karen Olanrewaju, director of Sunny Days, a Manalapan-based agency that serves some 3,000 kids. Keating said that for a while he wrote the DOH monthly to complain.

Many of the problems stem from the fact that data from the old system was not integrated into PCG’s model. Some agencies hired extra help with data entry; others turned to loans or lines of credit to pay their staff while they awaited a resolution, leaders said. Many are now submitting these additional costs to the DOH; Thomas said a final decision has not been made on how to address these claims.

Waiting for the backlog to clear

As for the $44.13 million the state dispersed in advance last year, Thomas said the DOH has proposed four “recoupment options”: a lump-sum payment, withholding 22 percent of weekly payments through the system or ten installment payments. A “hardship” option was also developed for agencies that have seen their business decline, which allows for graduated payments, starting in April and increasing throughout the year.

“The hardship model offers more relief at the beginning of the recoupment period while the back-logged claims continue to be processed,” Thomas added.

But the agencies and some lawmakers say any repayment must wait for true reconciliation of all the billing issues, past and present. The legislation advanced Monday (A-5271), sponsored by Assembly members Louis Greenwald (D-Camden) and Joann Downey (D-Monmouth), would require agencies to refund any advanced funding that exceeds the cost of their total claims; it also suggests that the state might owe some agencies more after all the claims are tallied.

Keating said the agencies have provided reams of old data and claims information — much of it in paper form — to the state to help reduce the backlog of claims that remains. Thomas said the department has worked with PCG, whose contract runs through the end of 2021, to expedite the processing of these bills, which should be complete by the end of August.

Even with the system working effectively for new bills, agency leaders said they are still struggling to be made whole, given the data glitches and delay in processing old claims. “It’s a constant chasing down of money,” said Barbara Cary, director of operations for TheraCare, which serves patients in New Jersey, the New York City area, and Connecticut.

“You wouldn’t want 90 percent of your paycheck,” she told lawmakers Monday. “That’s not good enough.”