Fargo, N.D.
Responding to escalating complaints from HME providers about delayed or improperly denied reimbursement, Noridian Administrative Services acknowledged in a mid-January statement that it had a backlog of more than 1,000 claims older than 90 days and 27,582 claims older than 61 days.
The Jurisdiction D DME Medicare Administrative Contractor said the number of claims requiring manual review was greater than it had projected when it took over from Cigna, the region's former DMERC, on Oct. 1, resulting in the backlog.
According to Noridian, from October to December 2006, it received 3,485,941 claims and processed 3,508,347 claims in that period.
While 80 percent of claims process through to completion without manual intervention, Noridian said, approximately 20 percent of all DME claims submitted “suspend” and, therefore, require manual intervention.
“We realize our high volume of suspended claims is impacting cash flow for some suppliers. We assure you that we are working on ways to reduce our claims inventory,” Noridian said, noting that it is hiring additional staff and its claims processing team is working overtime.
That's small comfort to providers in the 17-state region who reported backlogged payments.
“I think the time has passed for them to tell us why they are behind. All we really care about is for them to get caught up,” said Tim Pederson, CEO of Westmed Rehab in Rapid City, S.D.
Pederson said his company is down about $100,000 in payments. “Even a large provider is going to be hurt by that. We're living paycheck to paycheck with our payers.”
Angelene Adler, vice president of operations for Care Medical Equipment, an 11-branch provider based in Portland, Ore., said her company was waiting on most of the more than $3 million it is owed. “They tell us to wait 30 days, but we can't afford 30 days,” she said.
Neal Hansen of Hansen Homecare Specialty Service in Ketchikan, Alaska, said his small HME is definitely feeling the pinch, and the $20,000 it is out cannot come too soon. “We've had to dig into our reserves to pay our vendors. But you can't keep taking it out of the bag. You have to put it back.”
Hansen's company covers Ketchikan, its environs and Prince William Island. But with the payment delay, he is rethinking whether he can afford to service the island, which is accessible only by ferry.
“We have to pay $600 just to go over there,” he said. “We have to take the truck over and all the equipment, and you can't just come back. You have to stay two or three days and come back on the ferry.”
