This week the North Carolina Medical Society (NCMS) CEO Robert Seligson sent a letter to the Secretary of the North Carolina Department of Health and Human Services (DHHS) Aldona Wos, outlining our members’ on-going concerns with the payment rates for Medicare/Medicaid crossover claims.

The issue dates back to the July 1 launch of NCTracks, the new Medicaid claims system. At that point, Medicaid simultaneously implemented a new methodology for calculating payment rates on crossover claims where Medicare provides primary coverage and payment. 

Medicaid calls the new methodology “Lesser-of Logic,” and so far has issued only skimpy guidance about the change. In all examples seen so far, the Lesser-of Logic generates payment rates on Medicaid secondary claims that are lower – and often dramatically lower – than the rates paid on Medicaid secondary claims prior to July 1.  NCMS sees this as a surprise rate cut. We continue our strong efforts to resolve this matter with the DHHS.

Read the letter to Sec. Wos here.