Medicaid reimbursement changes

Anyone receive a letter from
NJ dept of human services regarding billing reimbursements for lab tests?

 

well what was the contents of the letter???

 

10 screens per person per month and only 2 confirmations per person per month. Although this change will put some of the shit bag labs out of business, many substance abuse clients will die because of it! It’s very sad. Covid has increased the need for comprehensive testing not decreased it.

 

2 test per MONTH? if that is the case, 24 confirmations a year???

that would be way out of bounds with what most medicaids and really any payer is doing....I would make sure about that analysis

 

Medicaid! Real life! Starts April!

 

2 confirmations a month but not on the same date of service as the screen. Which means a new sample needs to be collected. Also Tier 1 Confirms only and only 2 per month. Nothing above that. No confirming negative screens. Only able to confirm if a presumptive screen was run. The labs brought this on themselves by running benzos, opiates, k2, kratom, tramadol all by LC/MS/MS on every screen to get to Tier 2 & 3. This never should have happened. Some labs were averaging $250+ per sample. Not medically necessary! CROOKS!

 

What analysis moron? It says it in the new rule! 2 per month. Your an idiot!

 

Shady labs in NJ (Clarity, TrueTox, Ammon, SDX, Med Screen to name a few) are fighting hard to stop these changes. This tells me NJ Medicaid is correct. These labs billed $200+ per sample for testing not needed. They stole from NJ tax payers and now are crying. They have providers on board probably because of kickbacks like Ammon & their Foundation. You reap what you sow! I hope they all go bankrupt!!!!!!!

 

Two more days! Will labs survive? Labs were testing a few hundred samples/day at $250 a pop. A model built on Tier 3 & Tier 4 on every sample is not sustainable. NJ Medicaid is giving weekly data to NJ Comptroller, looking for fraud, not overbilling. Comptroller wants labs bad, especially TT! The rules are a trap for labs and providers as well. Ammon's charity payoff scam did not help. Everyone beware!

 

Let the bankruptcies begin! I give most of these NJ Tox labs 3-6 months before they go down. A bunch of criminals!

 

Spoke today with Medical Director of Drug Treatment site in NJ. Told me more changes coming from NJ Medicaid. Far worse than original newsletter:

- No definitive testing without doctor reviewing presumptive tests first
- Limited reasons for allowing definitive testing
- Doctor must provide new order with detailed reason for definitive test

Doctor stated no time for him to do what NJ Medicaid is asking. NJ Goal = eliminate 90% of definitive tests. The party is over!

 

The clock is ticking on which labs goes under first. My money is on Ammon, with Clarity & TT tied for 2nd. . Place your bets!

 

Spoke with reps at 6 NJ tox labs. Lab owners freaking out. Revenues down 50-60%! NJ did their jobs!

 

Crickets! Everyone focused on saving labs I guess.

 

NJ labs had to go back to clients and change the drug test panels, Did not go over well with the clients. This is what happens when labs fix panels to bill $250/sample.

 

Lab lobbying group claimed victory in changing this rule. The main rule still stands: Tier 1 definitive only, limited to to 2 per month. Wow, what a great job these labs did changing this rule. They are still seeing a max collection of $142 compared to $273! Plus audits will kill these labs. So stupid!

 

These shady labs telling clients to order 10 presumptive tests a month to make up for cuts! Clinics must have valid reason for 10 tests/month. This was a trap set by NJ Comptroller. Too stupid to see through the ruse!

 

I spoke with ST at NJ and he told me to be careful with telling sites to order more screens. NJ Comptroller is looking at pre-April 2021 ordering patterns and comparing to post April 2021 orders.

 

My commission for May are down 45%! This change is killing me.