NCMS Continues Efforts to End Rate Cut on Medicare/Medicaid Crossover Claims

This week the North Carolina Medical Society (NCMS) CEO Robert Seligson sent a letter to the Secretary of the North Carolina Department of Health and Human Services (DHHS) Aldona Wos, outlining our members’ on-going concerns with the payment rates for Medicare/Medicaid crossover claims.

The issue dates back to the July 1 launch of NCTracks, the new Medicaid claims system. At that point, Medicaid simultaneously implemented a new methodology for calculating payment rates on crossover claims where Medicare provides primary coverage and payment (see NCTracks Transition Includes Hidden Physician Rate Cut from Sept. 18, 2013).

Medicaid calls the new methodology “Lesser-of-Logic,” and so far has issued only skimpy guidance about the change. In all examples seen so far, the Lesser-of-Logic generates payment rates on Medicaid secondary claims that are lower — and often dramatically lower — than the rates paid on Medicaid secondary claims prior to July 1.  NCMS sees this as a surprise rate cut. We continue our strong efforts to resolve this matter with the DHHS.

Read the letter to Sec. Wos here.

This week the North Carolina Medical Society (NCMS) CEO Robert Seligson sent a letter to the Secretary of the North Carolina Department of Health and Human Services (DHHS) Aldona Wos, outlining our members’ on-going concerns with the payment rates for Medicare/Medicaid crossover claims.

The issue dates back to the July 1 launch of NCTracks, the new Medicaid claims system. At that point, Medicaid simultaneously implemented a new methodology for calculating payment rates on crossover claims where Medicare provides primary coverage and payment.

Medicaid calls the new methodology “Lesser-of Logic,” and so far has issued only skimpy guidance about the change. In all examples seen so far, the Lesser-of Logic generates payment rates on Medicaid secondary claims that are lower – and often dramatically lower – than the rates paid on Medicaid secondary claims prior to July 1.  NCMS sees this as a surprise rate cut. We continue our strong efforts to resolve this matter with the DHHS.

Read the letter to Sec. Wos here.

– See more at: http://www.ncmedsoc.org/blog/index.php/archives/27160#sthash.4u72Km1G.dpuf

This week the North Carolina Medical Society (NCMS) CEO Robert Seligson sent a letter to the Secretary of the North Carolina Department of Health and Human Services (DHHS) Aldona Wos, outlining our members’ on-going concerns with the payment rates for Medicare/Medicaid crossover claims.

The issue dates back to the July 1 launch of NCTracks, the new Medicaid claims system. At that point, Medicaid simultaneously implemented a new methodology for calculating payment rates on crossover claims where Medicare provides primary coverage and payment.

Medicaid calls the new methodology “Lesser-of Logic,” and so far has issued only skimpy guidance about the change. In all examples seen so far, the Lesser-of Logic generates payment rates on Medicaid secondary claims that are lower – and often dramatically lower – than the rates paid on Medicaid secondary claims prior to July 1.  NCMS sees this as a surprise rate cut. We continue our strong efforts to resolve this matter with the DHHS.

Read the letter to Sec. Wos here.

– See more at: http://www.ncmedsoc.org/blog/index.php/archives/27160#sthash.4u72Km1G.dpuf

 
 

More Posts in Bulletins

 
 

Share this Post



 
 
 

1 Comment

  • Raghuvir B Gelot, MD

    Payment of any amount from Medicaid crossovers would be appreciated. We haven’t received ANY crossover Medicaid payments since NC Tracks started July 1.