Financial Policy Committees and Workgroups

The TAC established guiding principles to guide NCHA on Medicaid reimbursement and financing decisions. Guiding principles include proper hospital funding for federal drawdown, ensuring payment follows care for Medicaid and uninsured programs, provides focus on access to care and the long-term durability of hospital financing of programs.

• Implementation Committee (IC): The IC focuses on the implementation of various financing programs as directed by the TAC through recurring meetings to review progress and manage development.
• Technical Data Working Group (TDWT): Supports the TAC in providing expertise on the financial data components necessary to carry out implementation of various programs. The TDWT has insight on cost report components, disproportionate share hospital (DSH) auditing, Medicare Administrative Contractor (MAC) audits, etc.

Guides NCHA in ensuring the NC Medicaid program maintains providers will be reimbursed for services provided, reduce provider administrative burden, and beneficiaries receive the care they need.

• Patient Financial Services (PFS) Subcommittee: Identifies systematic issues occurring on administrative and technical claims processes and reimbursement impacts. This committee assists the NCHA finance in meeting with managed care payers to discuss issues and provide additional context on reimbursement issues.
• Clinical Policy and Utilization Management Subcommittee: Proactively addresses the clinical and utilization management matters that impact Medicaid beneficiary access to care. This committee provides clinical expertise and assists NCHA finance in developing recommendations clinical policies, promote beneficiary access and ensure hospitals are reimbursed for medically necessary services.

Identifies process issues occurring in managed care plans (commercial and governmental) and seeks NCHA support to resolve items with payers and encourage process efficiencies.

Workgroup sharing best practices in implementing the requirements set forth on the No Surprises Act and dispute resolution requirements.

Workgroup sharing best practices in implementing the requirements of the Medical Debt Mitigation policy as set forth by NC DHHS as an opt-in condition for enhanced HASP payments.