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Glitches trip up Excellus

Rochester Business Journal
March 29, 2013

See correction below.

Extensive problems with Excellus BlueCross BlueShield's billing software have plagued physician practices for more than a year as the insurance carrier has struggled to remedy a software conversion gone wrong.
 
The software glitches-apparently stemming from an attempt to integrate billing systems of the Rochester Blues with the formerly independent Western, Central and Northern New York Blues plans and the Buffalo-area HMO that together make up the health insurer's $6 billion Upstate New York empire-have mostly flown under subscribers' radar.

But they have been a hot topic among the Rochester area's frustrated medical practice group administrators for at least 18 months, said Wendy Disbrow, chief administrative officer of FLH Medical P.C., a 20-physician, multispecialty practice with offices in Ontario, Seneca and Yates counties.

For Disbrow and people she confers with regularly at other area practice groups, Excellus' billing glitches mean an unrelenting stream of late and lost payments, spurious claim denials and other snafus, which requires that claims be resubmitted, sometimes more than once, she said.
 
The constant resubmissions are annoying but also costly. Submitting and resubmitting claims that should have been settled at their first submission strains her small staff, eating up work hours that could have been devoted to other tasks, Disbrow said. Perhaps more importantly, the glitches put a constant strain on cash flow.
 
FLH and most other area medical practices depend on the local Blues, which write well over half of the region's commercial health insurance policies, for an outsize slice of their revenues. For some time, Disbrow said, overdue Excellus claims have added up to a six-figure amount, swelling the aging receivables column on the practice group's books.
 
The Monroe County Medical Society regularly fields similar complaints from scores of physician offices, MCMS executive director Nancy Adams said. Several times a week she is on the phone with Excellus officials, seeking resolution or explanations for Blues claims gone astray. An email exchange for society members is full of alerts and complaints from practice administrators and billing clerks over Excellus claims foul-ups.
 
"We're nearing the end of our multiyear project to consolidate five claims-processing systems into one," said James Redmond, Excellus vice president of communications, in an emailed response to a query. "This has helped us modernize and standardize the way we do business. It has enabled many improvements in the way we support providers, and it has also caused some growing pains along the way.
 
"We continue to work with providers to assure the new system meets everyone's needs and improves the providers' experience with the new system," he added.
 
The growing pains to which Redmond referred appear to affect only physician practices.
 
Unity Hospital has not seen any particular problems with Excellus claims, said Unity Health System spokeswoman Natalie Ciao.
 
Claims submitted to Excellus by Strong Memorial and Highland hospitals are also mostly on track, said University of Rochester Medical Center spokeswoman Teri D'Agostino.
 
But URMC's roughly 1,000-physician Medical Faculty Group, which includes more than two dozen primary-care practice groups as well several specialty groups, is seeing a rash of late payments, claim denials and other foul-ups that require regular meetings between the medical group and Excellus officials, D'Agostino added.
 
"We've been tracking those issues," she said. "(Faculty group) payer representatives have been meeting with Excellus twice a month. Excellus is being very responsive, and we're working our way through it."
 
MCMS' Adams also is upbeat.
 
"I think we can see the light at the end of this tunnel," she said.
 
Excellus CEO Christopher Booth recently met personally with her to discuss the claims mishaps, Adams said, a gesture she sees as proof that the insurance company is taking the problem seriously.
 
When problems began to mount a year and a half ago, Disbrow said, some Excellus officials blamed them on the software the company is using to meld the five claims-processing systems into one. But since the area's second-largest health insurer, Schenectady-based MVP Health Care, uses the same claims-processing software and has not had similar problems, few accepted that explanation and Excellus soon dropped it.
 
And though Excellus initially was slow to acknowledge the problems, Disbrow added, the insurer for some months has owned up to the difficulties and been cooperative in straightening out each individual mess.
 
Still, Disbrow noted, the problems are longstanding and persistent. Frustratingly, each new billing foul-up seems to be unrelated to any previous one.
 
"It's like they fix one problem and it causes another one somewhere else," Disbrow said, speculating that in a "butterfly effect," each attempt to resolve a problem has an unintended consequence elsewhere and creates a new glitch.
 
Wherever the root of the claims mixups might lie, Excellus could indeed be getting a handle on the problem. Last month, it hired a chief information officer, filling a position that Redmond said had not existed previously.
 
In a statement announcing the hire, Booth called the new CIO, Wheeler Coleman, "the right person in the right position." Coleman has nearly 30 years of experience in health care information technology and last worked for a company that runs Blues plans with 13 million members in several states.
 
Though Disbrow finds such news encouraging, she is not entirely mollified. Making note of Excellus' $6 billion in revenues and roughly $1 billion in reserves, she said the insurer might consider reimbursing practices for costs incurred in the claims debacle.
 
After all, she said, while physician practices have scrambled to make sure that enough cash is on hand for payments to vendors and staff, "the premiums kept rolling in."

3/29/13 (c) 2013 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email service@rbj.net.

Correction
This correction appeared in the April 5, 2013 issue:


A March 29 article incorrectly identified Blue Cross Blue Shield of Western New York as part of Excellus BlueCross BlueShield.

4/5/13 (c) 2013 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email service@rbj.net.
 


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