Family practitioner Dr. Merritt Dunlap of Carson Medical Group in Carson City said he and many other local physicians feel trapped between a Medicaid system that isn't paying claims and malpractice insurance fees.
"Nevada Medicaid is a shambles, as are medical practices across the state. Primary- care groups are caught between a rock and a hard place," he said. "We can keep our practice open and abandon our patients, or keep seeing patients and watch our practice go down the tubes."
Since October, when First Health started making Medicaid payments in Nevada, claims submitted by Carson Medical Group have been repeatedly refused, to the tune of more than $600,000, Dunlap said.
The problems started after the computer system handling the state's Medicaid program was scrapped for a system designed to comply with new regulations designed to ensure patient confidentiality.
The computer rejected claims after the switch because of improper coding that adheres to the new system, said Teresa DiMarco, president of First Health Services.
"One 24-year-old obstetrical patient was denied benefits because the computer said her age was inappropriate for the treatment," Dunlap said. "Children's claims are coming back with a 1999 date, which the computer deems inappropriate.
"In the state's defense, they understand the problems, and they've been working with us," he said.
The state paid Carson Medical $200,000 in December, but its recent malpractice insurance bills, which totalled about $280,000, have put the 18-physician practice in a financial bind, Dunlap said.
An established practice in Carson City for 39 years, Carson Medical handles about 98 percent of all obstetrical care in the community. It provides four of the six local pediatricians and six family practice doctors, Dunlap said.
Medicaid recipients make up 15 to 20 percent of the patients at Carson Medical, most of them the neediest patients that Dunlap serves.
"Many are foster children, the elderly and adults with mild handicaps," he said. "These people have very real needs, and if they aren't seen in offices, they will go to acute-care emergency rooms or urgent care. The costs are higher, and the taxpayers will be left holding the bag."
State Medicaid Administrator Charles Duarte said the core computer system works, but there are problems with the table system. As a result, some of claims not paying correctly.
"First Health underestimated the complexity of these problems," he said. "We have a contract with them, and they know they need to fix the problems. A lot of issues have been resolved, and we're expecting substantial movement toward compliance, by Feb. 5."
Contact Susie Vasquez at firstname.lastname@example.org or 881-1212.