COVID-19: The Importance of Back Billing During a Crisis

Original story posted on: April 29, 2020

Back billing is key to remaining in business during COVID-19.

One of the questions that I have heard repeatedly during the continuing COVID-19 pandemic was why numerous clients were being prevented from working during a time in which we seemed to need so many healthcare providers.

One of my clients is an emergency room physician. He wants to be in emergency rooms, helping those in need. He is an absolutely capable, willing, and needed physician during COVID-19. But right now, he is on the Medicare exclusion list.

Another four of my clients have suffered financially because, at the time of the start of the pandemic, the Centers for Medicare & Medicaid Services (CMS) had temporarily suspended their admissions. Then things worsened, and CMS had bigger issues all of a sudden – understandably. With COVID-19, all four of these clients could have been overly busy and helping patients in need; these providers have the capability, the staff (for now), and consumers. But the timing of the pandemic prevented us from holding an in-person hearing on the merits to get these healthcare providers back to work.

We picked one client who was suffering the most and had enough money to try to go to the courts for relief during COVID-19. She owns two companies that provide home health – but because of technicalities or glitches, CMS had deemed them unfit to continue to serve consumers. Remember, that was a mistake – but we were now stuck in a pandemic, and the limited staff at CMS were focused on the immediate threat of COVID-19.

In our motion for a temporary restraining order, we argued that the public interest would be better served if this client healthcare provider were serving the community. We argued that our community needs her services now, during COVID-19. This particular client had been on prepayment review for over nine months. She hadn’t been paid for nine months, and was barely holding on due to loans. She was already suffering irreparable harm.

We got the injunction only two hours after the conclusion of our arguments. This client can now provide services, get paid, back bill for claims denied, pay her staff, and continue running her company, at least from now until May 4. On that day, the judge will revisit the injunction to determine whether it is still needed. We will tell the judge whether we need it continued, because we have no way of knowing now whether we will.

Regardless, for now, we are back in business.

From the language of the injunction: “due to the COVID-19 pandemic, there exists a substantial public interest in ensuring that home care providers such as petitioners are able to continue providing essential services to members community, in particular elderly, infirm, and impoverished individuals, in their homes.”

“Petitioners will suffer irreparable harm without the injunctive relief ordered herein, as they would be unable to continue paying their workers to provide essential home care for Medicaid recipients.”

“Based upon the foregoing reasons, respondent is hereby enjoined from terminating petitioners’ participation in the North Carolina Medicaid program until further Order from this Tribunal.”

Many of you must be thinking, why spend the money to obtain a preliminary injunction that only lasts until May 4? The injunction would have been helpful to this client even if it lasted only one day. Back billing is key to remaining in business during COVID-19. Since July 2019, North Carolina’s Medicaid program owes my client over $5 million for services rendered.

Just one day off prepayment review allows the client back billing to get reimbursed what is owed. And that is the importance of back billing.

Programming Note: Knicole Emanuel is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10-10:30 a.m. EST.

Knicole C. Emanuel Esq.

Knicole C. Emanuel is a partner at the Potomac Law Group, PLLC.

For more than 16 years, Ms. Emanuel has maintained a litigation practice, concentrating on Medicare and Medicaid litigation, healthcare regulatory compliance, administrative law, and regulatory law. She understands the intricate Medicare and Medicaid payment system, the unique business of healthcare providers, the overlay of federal and state Medicare and Medicaid rules and regulations, and actions of state agencies that affect the way healthcare entities operate. She has tried over 1,000 administrative cases and has appeared before arbitration panels and in various appellate forums. Knicole is a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

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