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, and provides focus on access to care and the long-term durability of hospital financing of programs. 

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

The Medicaid Managed Care Steering Committee guides NCHA in ensuring the NC Medicaid program maintains providers will be reimbursed for services provided, reducing provider administrative burden, and safeguarding beneficiaries’ ability to receive the care they need. 

• Patient Financial Services (PFS) Workgroup: Identifies systematic issues occurring on administrative and technical claims processes and reimbursement impacts. This workgroup 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 Workgroup: Proactively addresses the clinical and utilization management matters that impact Medicaid beneficiary access to care. This workgroup provides clinical expertise and assists the NCHA finance team in developing recommendations for clinical policies, promoting beneficiary access to care, and ensuring hospitals are reimbursed for medically necessary services. 

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