LAS VEGAS (KTNV) — A Las Vegas speech-language pathologist is now breathing a sigh of relief after finally getting her Medicaid contract revalidated.
“I’m so emotional, I could cry,” she said Thursday.
WATCH | Here's how we got to this point in her journey that Channel 13 has been following all week:
Emily Swogger shared her concerns with Channel 13 about keeping her therapy business open while dealing with a delay in getting her Medicaid contract revalidated on Monday.
She believes the delay was compounded by a temporary pause on all new provider Medicaid contracts nationwide as an effort to combat fraud in the industry. But she was operating without a valid contract as her application was not yet approved.
The Nevada Health Authority said in an email to Channel 13 that the pause only affects new providers looking to get enrolled in a Medicaid contract.
Channel 13 has been listening to her concerns and brought them directly to Gov. Joe Lombardo on Tuesday. He was at a polling place for the primary elections, thanking volunteers for his campaign and talking to voters.
“We're basically going off what she is saying,” said Lombardo in part of his response to our question. “So, we would like to confirm that, and that's easy to reach out to health services via the state either online or in person or on the phone. We can help her through that process.”
The next day, we went back to Swogger’s office and played the governor’s response in full.
“It would’ve been nice to hear him seem a little bit more shocked and concerned and maybe less defensive,” she said, adding she’d be happy to sit down with staff or the governor himself to talk through her concerns.
By Wednesday, she told Channel 13 she had a visit from some Medicaid officials and that she was encouraged that something was finally going to change and progress with her application.
On Thursday morning, Swogger reached back out to Channel 13 to share that the Medicaid Inspector General called her personally.
“She apologized profusely and offered her assistance in any way, kept me updated, pushed it along to the Medicaid supervisor, and I am just absolutely overwhelmed with joy that we are active again,” Swogger explained.
Emily said the Medicaid Inspector General also reassured her that the few days without a valid contract would not be considered a lapse, and that the services she is normally reimbursed for each week for her pediatric patients will be backdated. It’s money she didn’t think she’d see.
Lombardo’s office reached out Thursday and shared that their “office records indicate we received a call from Ms. Swogger on June 5th and June 8th. After receiving the call on June 5th, our office contacted the Nevada Health Authority to try to address her concern about her application and the approval of her license. Four business days later, her application was approved.
"The moratorium for hospice and home-health providers due to fraud, waste and abuse trends in this category is a separate unrelated activity from the standard provider revalidation process. The activities related to the moratorium should not affect the standard revalidation process for providers.”
They also provided this other information from the Nevada Health Authority:
Currently, Nevada Medicaid’s average processing time for these applications is 25 days; this includes from the date of a complete submission to the date of a decision for approval or denial by the state. If a provider sends an application that needs correcting, the average return time by the state to the provider to request additional information is 1.3 days. While we understand this may not be the experience of every provider, we do believe that the process has improved significantly in the last year with the rollout of our new online modernized process for completing revalidation applications—Provider Flex.
As always, we strive to improve the experience of our providers at Nevada Medicaid. To ensure a smooth process for revalidation, Nevada Medicaid strongly recommends that providers submit their completed applications at least 90 days before their revalidation deadline. This allows time for state processing, third-party verification, and resolution of any issues without risking a gap in the provider’s enrollment. Providers experiencing challenges with the revalidation process or the online application can reach out directly to Nevada Medicaid at ProviderEnrollment@nvha.nv.gov.
This all started because Emily came out to one of our Let’s Talk community events and shared her concerns last week.
We always invite anyone in our community to get out and chat with us at one of them so we can learn more about what issues are affecting Valley residents.
