Sneak Peek: N.Y. DOH Instructed To Deduct Income From Claims

October 13, 2011 | By Jerry Ashworth | Post a Comment

(This post is based on an upcoming article in the Single Audit Information Service.) New York health officials plan to evaluate ways to modify its Medicaid claims processing system to ensure the state pays nursing homes the appropriate level of Medicaid funds in response to overpayment concerns discussed in a state comptroller’s office audit.

New York pays about $6.8 billion in Medicaid to about 700 nursing homes to care for nearly 121,000 recipients. Many nursing home Medicaid recipients have income from Social Security, pension and other sources, which is referred to as net available monthly income (NAMI). Local nursing homes are responsible for determining the NAMI of those residents on an ongoing basis and report it to the state Department of Health (DOH) eMedNY claims processing system. The system deducts NAMI from the amount that Medicaid pays to the nursing home provider.

However, the New York Office of the State Comptroller recently found that Medicaid payments to nursing homes were not always being reduced based on their NAMI. It estimated that up to $42 million in Medicaid funds, about half of which was the state and local portion, were overspent to nursing homes during a the audit period from January 2007 to August 2010.

More information on the New York audit will be upcoming in the November issue of the Single Audit Information Service.

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