MedicaidWhoPaysClip.mov

CBS 6 of Albany delves into the issue of Third Party Liability for home care patients covered both by Medicaid and Medicare. Previously, the state and federal governments utilized a fair and efficient claims-sampling method (called the TPL Demo Project) to determine which program -- Medicare or Medicaid -- pays for home care services provided to tens of thousands of patients covered by both programs. That program expired in 2007. As a result, the state mandated that home care providers resubmit to Medicare thousands of prior-year paid claims, along with a mountain of related paperwork, to trigger a case-by-case redetermination of whether Medicare or Medicaid should have paid. This has cost providers thousands, in some cases millions, of dollars to achieve what the TPL Demo Project was able to resolve much more efficiently. New York's home care community is vigorously advocating for reauthorization of the TPL Demo Project at the federal level, which would save millions of dollars both for the government and for providers, removing an unnecessary administrative diversion from the provider's main task of delivering patient care.

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