BY JEFF CHUDZINSKI
North Country This Week

CANTON — St. Lawrence County’s opioid treatment program is struggling to make ends meet and at least one legislator says he’ll be looking to shut it down if the situation isn’t remedied.

The problem appears related to insurance reimbursement and billing issues, according to Community Services Director Jay Ulrich, who presented the clinic’s finances to the operations committee during the March 20 meeting.

According to Ulrich, who highlighted a number of concerns, the no-show rate dropped, but the decline did not answer why the number of visits also dropped.

As of March 20, a wait list for those seeking treatment sat at 21, with 13 agreeing to remain on the list. The remaining eight were notified by letter of the list and would need to respond to remain on the list, Ulrich said.

Ulrich told legislators that one area of concern is a lack of account clerks to assist with billing. Though one new hire is expected to be on board this week, that still leaves multiple openings, Ulrich said.

Another issue that has caused problems when attempting to collect reimbursement from insurance companies is incorrect insurance information for patients.

“We have been asking our clinicians to make sure we have updated insurances for patients, as well as at the front desk,” he said.

Billing information is also being sent via email, allowing patients to update their insurance information by sending a photo of their new card, Ulrich said.

But not all patients are seen in person, leading to more headaches for the clinic.

“People who aren’t seen in person, we assume they have the same insurance. Sometimes they don’t and the claim is denied,” he said.

In an effort to ensure all treatment is covered, secondary insurances are now being collected when patients come in for treatment as well.

But in some cases, certain Fidelis subsidiaries are not reimbursing for services, Ulrich said.

A recent switch to a new billing agency has also yielded similar results across the board, Ulrich said.

When opioid treatment program numbers are removed from what is being billed, the numbers are nearly identical to years prior.

“So it’s the OTP we’re still really struggling with,” Ulrich said.

Legislator Joseph Lightfoot questioned whether the numbers were down due to billing being refused by the insurer or because the treatment was not billed.

“It’s getting better, our preliminary numbers show 44.1% and we are getting revenues from as far back as six months. The numbers we have are not definitive as a result of that,” Ulrich said.

“We’re at the low end, aren’t we,” Lightfoot questioned.

Ulrich said at the moment the clinic is, however a medical biller with years of experience will be joining the staff in April.

“That will be a big help. Administrative services have also continued to learn the processes. Certainly, we’re going to do better than what we see here,” Ullrich said.

Figures presented to the committee show a 96.3% reimbursement rate for June 2022, followed by a steep decline to just 72.2% in July 2022.

Initial figures for Aug. 2022 showed 49% paid during the third month, with an additional 12.1% paid in the sixth month. The total of 61.1% just barely out paced the 60.5% collected for Sept. 2022.

For Oct. 2022, 58.2% was paid during the third month, while Nov. 2022 saw an even sharper decline to just 44.1%, according to the presentation.

Lightfoot questioned further if the recent trend will be the bellwether for future reimbursement percentages.

“I certainly hope that if we have people in there that have experience, as you say, that we will see a turn around. If you don’t see a turn around I will tell you that I will be one of the first to tell you we need to get out of the business,” he said.

Ulrich also mentioned an intern who is studying medical billing and similar services would be coming in the near future to assist as they finished their training and education.

“I hope it works,” Lightfoot replied.