I met this past week with some of our Health Information Management staff, Business Office staff, and our VP of Operations. It was an update meeting for me regarding our efforts to resolve some billing “projects”, as one managed care organization (MCO) calls them.

We have “projects” open with several managed care organizations. Projects usually involve numerous cases and are attempts to correct errors created by the MCO’s computer systems. Projects are created when the same error occurs multiple times. In our experience, projects delay payment for us by at least another 30 days.

Listening to our staff describe the intricacies involved in billing and re-billing, I was reminded of how simple billing was before managed care entered Louisiana’s child welfare system. Each month, Louisiana’s Department of Social Services mailed a document listing every foster child’s name. Beside each name was a place for the admission date and the discharge date. Next to these was a place for the number of days of care provided that month. At the bottom of the page, that last column was summed and multiplied by the daily payment amount. We mailed this back to DSS (now named the Department of Children and Family Services) and payment was made in a predictable, timely manner.

Before Healthy Louisiana, one person was able to manage all our billing for our children in just a day or two each month. Today, our efforts to receive payment from Louisiana for the foster children we care for require several staff members who work every day against the unnecessary friction of managed care.

It is tedious and frustrating work. One staff member told me about calling a Healthy Louisiana MCO and being transferred to four or five different employees until finally, a person working in New York explained that she really needed to be talking to the MCO staff in Louisiana!

The “friction of managed care” grinds on ….

Rick Wheat
President and CEO
Louisiana United Methodist Children and Family Services