I interviewed Michael and Cecilia McNeil — CEO and COO/CFO, respectively, of the Guidance Center in Chalmette — a few weeks ago for our story about ongoing operating issues with Clinical Advisor. Clinical Advisor, you may remember, is the new web-based Medicaid database and claims processing software provided to mental health rehabilitation centers throughout Louisiana by state contractor Magellan Health Services, the company coordinating the Louisiana Behavioral Health Partnership.
The McNeils said that between an inability to process claims — for which they received an advance payment from the company — and new state rules prohibiting billing for phone services, they were losing money and having to cut back.
"As of last Saturday, we've cancelled paid time off, holiday pay, licensure supervision [paying for staff member licensure training]," he says. "And effective the end of this month, our health insurance and life insurance policies will be canceled. ...
"The clients we serve now have a better safety net than our employees."
Today, they're informing us, they face imminent closure, which they claim is a direct result of the new Medicaid system. Read their press release after the jump.
April 3, 2012
To: Paul Dykes, CEO
Magellan of Louisiana
From: Michael R. McNeil, CEO
The Guidance Center, Inc
RE: Request for Assistance
Since March 1, 2012, The Guidance Center ("TGC") has continued to deliver behavioral health services to our Medicaid clients at the same level as was authorized as medically necessary prior to Magellan assuming the role of State Management Organization for the Louisiana Behavioral Health Partnership (LBHP).
The transition continues to be extremely difficult, primarily due to the many problems associated with Clinical Advisor, Magellan’s web based electronic health record that the former MHR providers have been asked to use for documentation and billing in the LBHP. Due to our inability to efficiently submit clean claims through Clinical Advisor as a result of these problems, we find ourselves in a severe cash flow crisis.
We are at the point where we will need to shut down our agency, unless we get some assistance from you immediately.
We appreciate the $110,000 that Magellan advanced to us as bridge funding, but that money is running out. That sum was insufficient to cover the cost of services actually rendered. Further, due to the problems we have encountered in submitting clean claims, we need to find a method whereby we can submit clean claims fast enough to keep up with the services being delivered.
TGC has over 700 clients in the LBHP. We want to continue to deliver services to these clients, we want to be paid for the services we deliver and to do both we need to get paid.
During the month of February 2012, TGC submitted claims to Molina (Medicaid) of approximately $90,000 each week and getting paid for them on a weekly basis. During the week of Mardi Gras, we submitted about $60,000 worth of claims. Historically, we experienced very few denials or delays in getting full payment for the claims we submitted.
Because of our inability to use Clinical Advisor, we do not know an exact figure of the reimbursable amount for the services TGC staff have delivered from March 1st to date. Our best estimate is around $70,000 per week.
Although we believe that the problems with Clinical Advisor being experienced by many providers throughout the state will eventually get corrected, it will not be in time for us to re-establish cash flow. We believe many MHR providers are facing the same dilemma, as a result of the billing and payment difficulties experienced with Clinical Advisor. Though we do not wish to withdraw as a provider in the LBHP, we may have no choice. Therefore, we are formally requesting the following assistance:
1. Automatic deposit of $60,000 each week into TGC bank account, until such a time as we can establish a steady cash flow.
2. Prompt assistance by Magellan staff when we call or email asking for help primarily because of error codes that Clinical Advisor is producing when we create and submit otherwise clean claims.
3. Delay in repayment to Magellan of this bridge funding until such a time as TGC can establish a routine cycle of billing and receipt of payment for services delivered.
4. Written acceptance of the above agreement from Magellan.
We appreciate the work of Magellan's staff to attempt to correct the many problems in Clinical Advisor. I know Magellan's staff, as well as provider staff, are putting in long hours in an effort to work through these issues. However, so far, these efforts have proven insufficient to sustain a provider.
Failing Magellan’s agreement to meet our above stated need, please provide us with any special instructions you would like us to follow in shutting down our business. We know our responsibility to our clients and routinely provide each discharged client with referrals to other community resources. Please advise if you would like us to refer all our clients directly back to Magellan through your member services hotline (1-800-424-4399).
In addition, to our knowledge, there is currently no way for us to enter a discharge/closure in Clinical Advisor, without blocking our ability to submit claims for services delivered prior to the discharge date. The last I heard, development of the ‘closure packet’ in Clinical Advisor was one of the priorities Magellan's staff was working on. We will need written instructions on a workaround for this issue as we clinically discharge/transfer our clients.
Please be advised, we will begin the discharge process of our 700+ clients the week of April 8th if we do not receive confirmation from you, in writing, that Magellan will provide the assistance we have requested above.
Thank you for your consideration.
Copy: Governor Bobby Jindal
Secretary Bruce Greenstein, DHH
Deputy Secretary Kathy Kleibert, DHH
Representative Kevin Pearson
Craig Coenson, Chief Medical Officer, Magellan of Louisiana
Louisiana State Board of Social Work Examiners
Louisiana Licensed Professional Counselors Board of Examiners
Charles Maldonado, Gambit