Well… if you are a NYS Medicaid provider, this week, and last, was the
beginning of a rude awakening.
First and foremost was the reduction of the Medicaid secondary payments
for Medicare recipients. Instead paying the balance of the Medicare 20%
co pay, NYS Medicaid will now pay 20% of the 20%. On a 100$ Medicare
claim, when Medicare pays $80, and Medicaid use to pay $20, they will now
pay $4. OK that’s tough enough…but we knew it was coming…BUT HIDDEN
IN THE FINE PRINT…was the following reality:
Medicaid is now retroactively recouping all the monies they paid prior to
their being able to get their system up to speed, and able to make the
adjustments to how much of the co pay they would pay. What that means in
$’s is that all claims paid secondary to Medicare, by Medicaid, at the
full 20% co payment, dating back to July of 2003, will now be recouped
from payments presently due. Despite the fact they told us to continue to
bill as we had been billing, and they continued to pay as they had been
paying. So…if in August of 2003, Medicaid paid you the $20/20% balance
on that $100 Medicare claim, starting this week they are coming after you
for the $16 YOU WERE OVERPAID !!!!!!!!
Talking with CSC (who work for Medicaid processing these claims), we did
absolutely nothing wrong. We did exactly what Medicaid directed us to do.
They were very sympathetic…but they work for Medicaid after all.
As small a facility as I am, this has already cost me several thousand
$’s in lower reimbursements and recoup payments. I was told by another
facility, they had close to $4000 recouped in just this 30 day payment
cycle. We are all bracing for the #$&^% to hit the fan as Medicaid start
withholding payments to recoup $’s…THAT’S NEW YORK STATE POLITICIANS
FOR YA!!!! WHAT A GREAT LAW…WHAT A GREAT BUNCH WE HAVE…HOW THEY LOVE
SMALL BUSINESS IN NY…
My purpose is not just to gripe…it is to ask NYS Medicaid providers to
get into action. I do not see anyone, any organization, standing up to
face these issues prior to their becoming this kind of nightmare. If it’s
not a grass roots effort in NYS, it does not seem to exist. Think about
how many 20%’s you’ve collected from your Medicare patients who have
Medicaid, and start adding up what Medicaid is now going to start taking
back FROM YOU. Can you afford to be silent? I’m a small facility, it
will hurt, but I can whether the storm…I think. Do you recognize that
this is the beginning of a trend unless we stop/reverse this NOW!!! If
this flies, do you think Medicaid will stop with Medicare co pays?PLEASE
… START WRITING LETTERS, SENDING FAXES, SENDING E-MAILS, MAKING
CALLS…if we are active enough maybe we can at least stop the recoup,
and maybe even reverse this crazy trend.
Pick Pocketed by the State of NY
Michael P Madden, BOCPO, C.Ped
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