AUGUSTA — The state Department of Health and Human Services announced that the federal government has certified its Medicare and Medicaid claims system.
The previously substandard claims system had prevented DHHS from receiving full federal reimbursement on benefit claims. The state’s billing system has failed to meet federal standards since 2005, forcing Maine’s federal reimbursement rate 25 percent lower than states with billing programs in compliance.
The federal certification of the system means that Maine claims will be reimbursed at 75 percent, up from the previous 50 percent. According to a release from DHHS, the increased reimbursement will be retroactive to Sept. 1, 2010.
DHHS officials said Tuesday that the retroactive reimbursement was built into the department’s biennial budget approved by the Legislature earlier this year. That means the certification won’t impact the DHHS $220 million budget shortfall the state is currently confronting.
DHHS officials were preparing for a work session with the Legislature’s budgetary committee to parse Gov. Paul LePage’s sweeping overhaul of the state’s Medicaid system.
In a press release, DHHS Commissioner Mary Mayhew said she was pleased that the federal Centers for Medicaid & Medicare had approved the system.
“While we still have some work to do, CMS’ decision confirms that our claims management system is of high quality and will serve DHHS and those who provide services for years to come,” she said.
The administration has heavily criticized the previous claims system, which it said has played a significant role in creating funding shortfalls.
The system had been replaced in 2010, however, DHHS officials had been working with CMS to get it certified.
Since Sept. 1, 2010, the Maine Integrated Health Management Solution system has been processing approximately one million claims a month and paying nearly 3,000 providers each week.
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