MSA Urged to Continue Enhanced Payment for Neonatal Intensive Care Services

Posted on July 19, 2019

The MHA submitted comments to the Medical Services Administration (MSA) July 19 regarding the department’s long-standing reimbursement policy for neonatal intensive care unit (NICU) services provided by 23 hospitals throughout Michigan. These comments were in response to the MSA’s efforts to review existing Medicaid policy after hospitals experienced numerous claim denials for NICU services provided to Medicaid managed care organization (MCO) patients. To review the issues, the MSA held a meeting in early May of a workgroup comprised of representatives from hospitals, MCOs, the Michigan Association of Health Plans and the MHA.

Under current policy, the MSA provides a higher payment through an alternate weight in the All Patient Refined Diagnosis Related Group system to recognize the higher cost incurred by hospitals to maintain NICU services. Historically, the MSA has instructed designated hospitals to use revenue code 0174 for patients that were in the NICU to qualify for payment based on the higher alternate weights. This practice has resulted in increased scrutiny and denials for NICU claims for MCO patients, since the National Uniform Billing Committee guidelines for using revenue code 0174 do not align with the MSA policy. 

The MHA and hospitals urge the MSA to maintain the higher payments for NICU services to ensure continued access to these vital services. Members with questions should contact Vickie Kunz the MHA.  

Tags: Medicaid, MSA, comments, neonatal care services

Posted in: Member News

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