One Important Thing: Medicaid Reimbursement

One Important Thing: A reimbursement policy contained in Virginia’s new biennial budget is designed to reduce Medicaid reimbursements for emergency care if the visit is deemed, after the fact, to be avoidable/non-emergent. We sent a letter to Centers for Medicare and Medicaid Services this week asking them to take action and reverse this decision in Virginia.

Details:

• Under the budget, Medicaid reimbursements would be cut to $14.97 if an ER visit is deemed by Medicaid or managed care organizations (MCOs), post-treatment, to be “unnecessary."

• We believe the Prudent Layperson Standard obligates Medicaid programs and MCOs to reimburse doctors and hospitals for the delivery of emergency medical care based on presenting symptoms, and not using diagnosis lists.

• Such reimbursement is not sustainable and threatens the emergency medicine safety net.

• For further reading: See the letter to CMS and review the Low Acuity Non-Emergent ER Diagnosis Code List, which would result in down-coding.