SLC Clinics Missing Out on Money After Mistakes on Insurance Claims, Missing DeadlinesPosted: Updated:
Last year, St. Lawrence County clinics missed out on $500,000 in insurance payments.
That's money county taxpayers had to make up. The culprit?
Mistakes on insurance claims, missed deadlines and other snafus.
It's been going on for while. Just during the past three years shortfalls add up to well over one million dollars from missed reimbursements for services like treatments for drug and alcohol abuse.
“The primary objective is that we get paid for every service we provide," said John Burke, district 12 legislator in St. Lawrence County. "And that's where we have failed.”
Community Services was without its own full-time director for two years. Last year, Jay Ulrich was hired. He acknowledges the agency needs to learn to meet deadlines and be assertive.
“When you bill in a more timely manner you have more time to process the denials. And to followup on those claims,” said Ulrich.
In the spring, the county hired an outside firm to handle some Community Services billing tasks. It has gone from 67 percent of claims paid to 77 percent.
“We have a lot of eyes on our billing system right now. You know, we're pretty transparent,” said Ulrich.
Still, Burke said the full scope of the problem may not be reflected in those numbers. He feels many services were simply never billed for, particularly complex ones. He is the legislature's liaison to Community Services.
“That's the unknown part we still have to wrap our arms around," said Burke.
Burke said Community Services may in fact have missed out on more than $2 million in insurance payments in the last few years.
It remains to be seen how much improvement can be made. Legislators want the critical services offered to continue and even improve. However, they don't want taxpayers to pay any more than they have to.