Reimbursement for hospital outpatient services has changed

Pursuant to SL 2013-360, Section 12.H.13.(e); reimbursement for all hospital outpatient services, except laboratory, has been reduced from 80% of costs to 70% of costs. This change was implemented on the weekend of February 8-9, 2014. Any claim that is adjudicated to a paid status on or after that change date will reflect this reduction in payment. Since most of the hospital outpatient claims paid on the February 11 checkwrite were adjudicated prior to the change date, this reduction in reimbursement may not yet be as evident.

Since SL 2013-360 requires an effective date of January 1, 2014, DMA will be requiring CSC to recoup and repay all outpatient claims with dates of service on or after January 1, 2014. Providers will be notified prior to the reprocessing of the previously paid claims.