Colorado hospital sees 5 times more unpaid claims following state Medicaid system implementation

Aspen (Colo.) Valley Hospital has seen its average number of paid Medicaid claims decrease from 85 percent to 66 percent following implementation of Colorado's new payment processing system for such claims, according to the Aspen Daily News.

This means the hospital has seen five times the amount of unpaid, three-month-old Medicaid claims it normally does, according to the report.

Colorado rolled out its new Medicaid payment processing system in March. Following the rollout, AVH Revenue Cycle Director Debbie Essex told the Aspen Daily News the model has not properly handled processing of Medicaid claims.

AVH normally has about $30,000 in unpaid Medicaid claims that are more than three months old, according to Ms. Essex. But the number is currently $150,000.

AVH is not alone. Colorado Hospital Association spokesperson Julie Lonborg told Becker's Hospital Review via email, "While we believe the state is working to address the issues with their new system, the level of denied claims has reached an unsustainable level and Coloradans' access to care through Medicaid is being threatened." She specifically cited a CHA survey of a representative sample of its members. She said the survey showed 38 hospitals don't have more than $211 million in expected Medicaid reimbursement for a four-month period.  

"For many smaller or rural hospitals, these missing payments threaten their ability to continue providing this care. Essentially, hospitals and providers have been performing quality assurance checks on a system that wasn't ready for prime time," she added. 

Editor's note: Becker's Hospital Review reached out to the Colorado Department of Health Care Policy and Financing and will post additional details as they become available.


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