When NCTracks launched on July 1, 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. Link to that publication here and note the explanation in Example 2.
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.
Over the previous week, NCMS has communicated its strong objections to Medicaid leaders about this surprise, unauthorized rate cut. We question its legality, and continue to urge Medicaid to restore the pre-July methodology immediately. If our direct efforts with Medicaid do not bring a satisfactory resolution, we plan to take our advocacy efforts to other venues.
NCMS encourages you to share this latest complaint about NCTracks with your elected officials. The Carteret County Medical Society took this message to heart and recently hosted state Rep. Pat McElraft and Sen. Norman Sanderson to discuss NCTracks and the negative impact the transition has had on patient care and the financial wellbeing of medical practices.