Quick Action Limits Another Medicaid Rate Cut and Recoupment

Immediate action by the North Carolina Pediatric Society and the North Carolina Medical Society (NCMS) has drastically curtailed the latest effort by the NC Division of Medical Assistance (DMA) to recoup claims payments from physicians. This marks the third time in 2017 that NCMS was involved in a successful advocacy effort that protected its members’ bottom line.

Last Thursday, NCMS was alerted by pediatricians and NCMS members Graham Barden, MD and Christoph Diasio, MD of DMA’s plan to reprocess/recoup NC Health Choice claims from Jan. 1, 2014 through March 1, 2015 as part of the excruciatingly drawn-out implementation of the North Carolina General Assembly’s 3 percent Medicaid rate cut from 2014.

NCMS, in turn, immediately intervened with DMA, arguing that state law protected both Medicaid and Health Choice payments in 2014 from the 3 percent cut for primary care physicians (PCPs) who successfully attested for enhanced Medicaid payments under the ACA.

After considering our position, DMA officials communicated their agreement on Friday, along with their decision to abandon the 3 percent cut on 2014 Health Choice claims for the attested PCPs. (Note that PCPs may still see recoupments on Health Choice claims from the first three months of 2015.) DMA also intends to send a revised notice to the affected physicians explaining the change.

Read about the other NCMS advocacy victories that have helped your practice so far this year: NC Medicaid Drops Provider Rate Cut and Administrative Nightmare Avoided – Thanks NCMS!


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