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 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.

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) 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 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.