As you may be aware, November 1, 2018 marked the implementation of the law establishing a $140 Medicaid emergency room triage reimbursement fee for low-acuity ED encounters that was approved as part of the Budget in June. As a result of NJACEP’s advocacy in June during the Budget process, this law ONLY applies to low-acuity FACILITY reimbursement fees for emergency and NOT professional fees associated with these visits. To view the ED Triage Reimbursement Non-Emergency Diagnosis Codes, CLICK HERE.
NJACEP with our colleagues at the NJ Hospital Association and NJ Hospital Alliance remained engaged with the NJ Department of Human Services and the Division of Medicaid through the process of defining “low acuity” and the codes associated with the $140 triage rate. Drs. Langer, Hochman and Eisenstein played a significant role with the Medicaid Medical Director and their in-house Medicaid billing specialists to discuss real-life clinical encounters to help limit the outpatient codes that would be deemed non-emergent and low acuity when implemented, particularly helpful with mental health exclusions.
So, we are pleased to report that DHS after consideration of the NJACEP and hospital input has decided to drastically limit the outpatient codes that would be deemed non-emergent and be subject to receive the $140 triage rate from the initial list of 17,000 outpatient codes to about 1,200 codes. The Budget estimated $29 Million in state savings from this initiative however with the Commissioner’s definition of low acuity; these changes will only save $1Million.