Revised Reimbursement Methodology for Medicare/Medicaid Dually Eligible Clients

Pursuant to the recent changes to Social Services Law, the NYS Department of Health has revised the Medicaid reimbursement methodology for practitioner claims for Medicare/Medicaid dually eligible individuals. Medicaid no longer reimburses partial Medicare Part B coinsurance amounts when the Medicare payment exceeds the Medicaid fee or rate for that service. This change to the reimbursement methodology is effective for dates of service on and after July 1, 2015. Claims with dates of service 7/1/15 or after that were processed before the revision of payment methodology was implemented on 12/17/15 are now being adjusted so that correct payment can be made. These adjustments will start to be seen on cycle 2007 with check/EFTs dated 2/8/16.

Source: https://www.emedny.org/listserv/Podiatry/podiatry_archive_emedny_listserv.aspx