DMA Finally Publishes Guidance on Medicaid Recoupment

Two months after NC Medicaid hit physicians with a surprise year-end recoupment, the Division of Medical Assistance (DMA) has finally published guidance for affected medical practices thanks to the persistence of the North Carolina Medical Society (NCMS). The information now is available on the NCTracks website FAQ page.

In a letter to NCMS dated January 27, DMA apologized for its handling of the December recoupment and promised to promptly post FAQs with additional information that NCMS requested on behalf of our members. After our repeated requests over the last two months, the information was published today.

Details Shared with NCMS

DMA also shared with NCMS an unpublished draft Frequently Asked Questions (FAQ) . Much of the information in the FAQ document, which addresses the December recoupment and related challenges, is good news. In particular, the FAQ explains that thousands of claims completely denied in the December recoupment because Medicaid later discovered other insurance coverage (known as “third party liability” or “TPL”) was available for many Medicaid patients. In FAQ number three, DMA states that it has decided to reprocess ALL of the claims that denied for TPL in last December‘s recoupment. As long as the claim is otherwise “clean” it should reprocess and pay at 97 percent of the original payment amount you received. DMA does not have a target date for the reprocessing, however.

In the meantime, NCMS suggests not pursuing reimbursement from the primary payer since you could receive payment from DMA through their reprocessing effort.

Please continue watching the Bulletin for updates as we continue working on this. If you have further questions, please contact NCMS Solution Center Coordinator, Belinda McKoy.

 
 

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