WASHINGTON D.C. - After discussions with several local ambulance and health care providers, as well as EMS officials with the Oklahoma State Department of Health, U.S. Congressman Dan Boren is calling for an investigation into the inefficiencies of administrative services and claims management by the Center for Medicare and Medicaid Services’ (CMS) intermediary company, Trailblazer Health Enterprises, LLC.
Trailblazers is currently the CMS intermediary servicing health care providers in Oklahoma and surrounding states with Medicare and Medicaid reimbursement claims.
Citing several issues raised by local, rural ambulance service providers regarding questionable claim delays and denials; on-going customer service problems; and misinformation about established billing procedures, Boren is concerned that many local ambulance service providers will be soon forced to shut down.
“During a time of economic downturn and rising costs for healthcare, we should be doing everything possible to ensure that all health care options are available to our rural communities and families – especially our emergency services,” said Boren. “It would be a disaster if these inefficiencies are responsible for emergency service companies closing their doors.”
According to state health care officials, Medicare and Medicaid reimbursements provide approximately 50 to 70 percent of a local ambulance service’s income depending on the location. Many of those rural providers operate on very tight budgets to perform their critical emergency services. When these claim reimbursements are delayed, and are penalized for the length of time the bill has been open, it has a significant negative impact on companies operating budgets.
“These rural ambulance providers form a critical health care safety net for thousands of Oklahomans. We cannot afford to wait until Trailblazers’ mismanagement drives them out of business. They need to provide us some answers about their inefficiencies, their general lack of customer service, and their reluctance to address these issues.”
In addition to the issues with claims processing and reimbursement, many Oklahoma health care providers also cite several examples of poor customer service when dealing with Trailblazers, and in many cases a total lack of communication.
Finally, an overwhelming majority of health care claims processors utilize the ICD-9-CM as the standard manual health care billing and claims management. As an intermediary between CMS and Oklahoma health care providers, Trailblazers’ refuses to the use this manual.
In addition, many health care providers assert that Trailblazers does not notify them of this until after a claim has been rejected the first time. The provider must then obtain the regulations Trailblazers utilizes causing even more delay to the claims process.
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