Industry News: New York

The Department of Health notified providers on November 3, 2011 that due to the delay in implementation of the required 2% Across the Board reduction to most Medicaid payments, a reconciliation of paid claims would be done in order to determine provider liability for the retroactive period from April 1, 2011 effective date to the implementation date on November 3, 2011.

Medicaid presently pays practitioners the full Medicare Part B annual deductible and partial Medicare Part B coinsurance amounts (20 percent of the Part B coinsurance) for Medicaid covered services provided to Medicare/Medicaid dually eligible recipients. However, the full Medicare Part B coinsurance amount is reimbursed for procedures if the service is not covered by Medicaid. This payment policy is changing. Effective October 1, 2011, NY Medicaid will no longer reimburse practitioners any portion of the Medicare Part B coinsurance amount if the service is not covered by Medicaid.

Administers the Medicare Part A contract for the states of Connecticut, Illinois, Indiana, Kentucky, Michigan, New York, Ohio, Virginia, West Virginia, and Wisconsin. They also administer the Medicare Part B contract for the states of Connecticut, Indiana, Kentucky, and New York.

The National Government Services Connex online inquiry application offers providers and suppliers the ability to:
• receive claim status;
• receive beneficiary eligibility information;
• view provider demographics;
• view financial data, and
• order duplicate remittances.

The final 2010-11 State Budget (Chapter 313 of the Laws of 2010) requires across the board reductions to most undisbursed general fund and state special revenue aid to localities appropriations (including Medicaid, school aid, social services, etc.,) effective September 16, 2010. Based on this recently enacted statute, the State is implementing a 1.1% across the board reduction to all Medicaid payments that
are processed on or after September 16, 2010. The reduction will remain in effect through March 31, 2011.

Services exempt from the reduction include: