NC DHHS: Medicaid Is Reducing Errors, Planning An Overhaul

Apr 6, 2016

The North Carolina Department of Health and Human Services says it's working to reduce the error rate in Medicaid payments to providers and hospitals.

A new report from State Auditor Beth Wood says North Carolina improperly spent $835 million last year.

But DHHS says they're improving. Dave Richard is the Deputy Secretary for Medical Assistance he says this year's audit reported that DHHS had a 13-percent error rate, down from 24 percent the year before.

Richard says this year's error rate should be even lower. He says they dispute many of the cases of whether a provider offered enough documentation on services, or accounting for rate changes over time. Still, Richard says the audit is helpful, and encourages, for example, educating providers on how to correctly bill for services.

"Providers range from highly sophisticated providers to others that are, you know, not as sophisticated in terms of record keeping. And we need people to be able to do that properly."

Richard says North Carolina's error rate is probably closer to 7-percent, which he says is below the national average.

He says plan to restructure the state's Medicaid system will simplify the state's payment process, but that DHHS will still need to review how money is distributed to providers.
 

Hearings On Reform Plan

NC DHHS is collecting public comment on its plans to overhaul the state Medicaid system. The agency needs federal approval to move from a fee-for-service model to one where the state pays flat rates to managed care organizations.

Dave Richard says the meetings around the Triangle last month were well-attended.

"We talk a lot about how we'll create new ways of engagement from providers to beneficiaries. So, one of the things that we are hearing from folks is that when you do that, you don't increase the administrative burden because that'll make it hard for people to be part of the process."

DHHS hearings are in Western North Carolina today, and will be in Greesboro and Winston-Salem later this week. They'll hit points in the eastern part of the state before the public comment period closes April 18th.