Knicole Emanuel

Knicole Emanuel

Williams Mullen

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Black and Blue Medicaid Budgets, the ACA, and the Fear of the Unknown…

The unknown is what creates fear, right? For example, my husband is scared of heights. It is not the “heights” per se that scare him. He says that when he is high up, he gets an abnormal and understandably disturbing sense...more

2/4/2014 - Affordable Care Act CMS Healthcare Healthcare Reform Medicaid

Medicaid Card Warning: This Card Could Cause the State to Recoup From Your Estate!

Have you ever wondered about warning labels? I mean, some of them are so ridiculous that you have to wonder who the person was that created the need for such a ridiculous warning label. For example, the warning label...more

1/28/2014 - Estate Claims Medicaid

Possible Hospital RAC Audits in 2014: Pow! Right in the Kisser!

Whew…it’s a new year. While I thoroughly enjoyed 2013, I am excited and hopeful for 2014. Work is so busy that it seems like I’ve barely had time to breathe this January….that’s a good thing, right? Hey, anyone see me on...more

1/23/2014 - Audits Healthcare Hospitals Medicaid RACs

NCTracks Derailed: Class Action Lawsuit Filed!

My law partner Camden Webb and I filed a class action lawsuit today alleging on behalf of medical providers who accept Medicaid in North Carolina. ...more

1/16/2014 - Class Action Healthcare Medicaid

An Ominous Cloud Looms Over NC’s Mental Health System! And Radix Malorum Est Cupiditas!

Two phrases that can never be good when linked together: “an ominous cloud” and “mental health care system.” Upon reading “ominous cloud,” I get this dark (dare I say ominous?), dreary outlook on whatever the “ominous cloud”...more

1/15/2014 - Healthcare HHS Mental Health Parity Rule Mental Illness

NC Medicaid: With Diaz Gone, Who Will Provide the Cheery Soundbites About NC DHHS?

You know you know someone like this! No matter how horrible the circumstance, they just say positive things. You know, like a Disney character…oblvious to reality. Think about Snow White…her step-mother wants to kill her,...more

1/9/2014 - Medicaid

DHHS Blunder Could Cost Millions! “Oops I Did It Again!”

We can add one more “oops” to the Department of Health and Human Services (DHHS) repertoire of “oopses.” I am reminded of Captain Edward Smith when he banged the Titanic into an iceberg. Talk about an “oops” moment. Not to...more

1/8/2014 - Healthcare HHS HIPAA Medicaid Penalties

Hello, 2014! And Hello 3% Decrease in Medicaid Reimbursements (But Call the Decrease “Shared Savings”)

Tomorrow is the first Medicaid checkwrite for 2014. With the first Medicaid checkwrite tomorrow, due to Session Law 2013-360, many health care providers will receive 3% less in Medicaid reimbursements. You will receive a 3%...more

1/7/2014 - Healthcare Reform Medicaid Reimbursements

Medicaid Providers: Do Not Omit Information on Your Medicaid Application or NC Ct of Appeals Says, “You Can Lose Your Medicaid...

We’ve all told our share of little, white lies, right? “Yes, honey, you look fantastic in that dress!” Or… “I never think about my ex-boyfriend!” But omissions are also lies. People have told me in the past that omissions...more

1/3/2014 - Contract Formation Medicaid Omissions

CCME’s Prepayment Reviews Violate NCGS 108C-7!! Seriously!!

A few months ago I sent a public records request to the Division of Medical Assistance (DMA). I eventually received the information…today. I wanted to know how many providers had been put on prepayment review. ...more

12/27/2013 - Healthcare Professionals Medicaid Physician Medicare Reimbursements Physician Payments

CMS Declares the Payment Structure for the MCOs Violates A-87…”So What Happens Now?”

In North Carolina, we set up managed care organizations (MCOs) to manage behavioral health care for Medicaid. For the past year, I have been blogging that the MCOs’ payment arrangement with the Department of Health and Human...more

12/19/2013 - CMS Healthcare Healthcare Reform HHS Medicaid

If Men Are From Mars and Women Are From Venus, Then DHHS Is From Dune!

Without question, men and women see things differently. We process things differently. Which, of course, is why John Gray, Ph.D’s book “Men Are From Mars, Women Are From Venus” was such a huge success....more

12/12/2013

The Assassination of Caesar, the Utter Ineptness of NCTracks, and Ignored Warnings

When Caesar was warned to “Beware the Ides of March,” Caesar would have known that the soothsayer was warning him about March 15th…a date certain. Similarly, the Department of Health and Human Services (DHHS) was...more

12/10/2013 - Affordable Care Act Healthcare HHS

Could NC Hospitals Be the Surprising and Much Needed Advocate for Mentally Ill Medicaid Recipients?

North Carolina has created the perfect storm when it comes to mentally ill…the perfect scenario for disaster. From 2001 to 2012, the total population of North Carolina increased from 8,203,734 people to 9,781,022. Over 1 and...more

12/10/2013 - Healthcare Hospitals Medicaid Mental Illness

Attention Medicaid Providers: Potential SPA Decreases PCS Rates By 60 Cents Per 15 Minutes

The North Carolina State Medicaid Plan (State Plan) is constantly revised. The result of its constant revisions make for an 1800+ page, jumbled mess of plans, rules, amendments, and effective dates that make the State Plan...more

12/5/2013 - Healthcare HHS Medicaid Personalized Medicine

Extrapolated Medicaid Audits Continue: Be Proactive! (Or Move to West Virginia)

Extrapolated audits are no fun, unless you work for a recovery audit contractor (RAC). You get a Tentative Notice of Overpayment (TNO) that says the auditor reviewed 100 dates of service (DOS), found an overpayment of...more

12/3/2013 - Audits Healthcare Medicaid Overpayment

MMIS and NCTracks: New is Not Always Better

New is not always better. In December 2008, the Department of Health and Human Services (DHHS) awarded a contract to Computer Sciences Corporation (CSC) to develop and implement a replacement billing system for Medicaid...more

11/27/2013 - Billing Contractors Medicaid

Lawmakers Demand Accountability as to NCTracks Debacle (Finally) and the Action of Nonaction

Yesterday (11/20/13), State Auditor Beth Wood appeared before the Joint Program Evaluation Oversight Committee meeting. Lawmakers and Wood criticized NCTracks, its rollout, and the lack of accountability on the part of the...more

11/22/2013 - Healthcare HHS

To Decrease Medicaid Spending (Without Decreasing Medicaid Recipients’ Services), Drastic Administrative Cuts Are Needed

It is indisputable that reigning in Medicaid costs is one of this administration’s top priorities. And, I agree, reigning in Medicaid costs should be a top priority. In fiscal year 2011, it is estimated that Medicaid...more

11/19/2013 - Healthcare HHS Medicaid

DHHS Still Claims NCTracks on Track?? CSC Doing Its Best?

Today the Joint Legislative Oversight Committee on Health and Human Services met at noon. Mr. Joe Cooper, DHHS’ Chief Information Officer, spoke on behalf of DHHS. He began by explaining that NCTracks is not NC Fast, which...more

11/19/2013 - Healthcare HHS Medicaid

In the Future, Could Physicians Be Forced to Accept Medicaid?

According to a report in the “Mason Conservative,” Virginia Democrat delegate candidate, Kathleen Murphy, stated, during a debate, that the government should force physicians to accept Medicaid. After reading that, how many...more

11/14/2013

The Future of NC Medicaid Behavioral Health: Will We Soon Be Down to Eight MCOs? Two More Monkeys Jumping off the Bed?!

Remember the song “10 Little Monkeys Jumping on the Bed?” Ten little monkeys jumping on the bed. One fell off and broke his head. Mama called the doctor and the doctor said, “No more monkeys jumping on the...more

11/13/2013 - MCOs

Is Sec. Aldona Wos Challenging the Goliath - Like MCOs? Will She Win?

I attended a Women in Leadership conference the other day. The keynote speaker asked for us to come up with a one sentence mantra or mission statement that we would use to describe our purpose in life. I had never thought...more

11/11/2013 - DHS Drug & Alcohol Abuse Healthcare MCOs Medicaid Mental Illness

NC is #1 in USA!! (For Highest Percentage Increase in Total Medicaid Spending)…and What About the Rest of the USA?

On October 21, 2013, the magazine Modern Healthcare published an article, “Medicaid budgets By State,” which showed each state’s total Medicaid spent in 2012, total number of Medicaid enrollees in 2012, and average spending...more

11/5/2013 - Medicaid State Budgets

DHHS Takes 35 Years to Become Federally Compliant With Medicare/Medicaid Crossover Issues

It is without question that the implementation of NCTracks has been a complete debacle. NCTracks is the new computer system that is processing Medicaid claims for all health care providers who accept Medicaid in North...more

11/4/2013 - HHS Medicaid Medicare

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