Posted in NY Providers, Training, Updates

NY Providers: What does “Medicaid ATB Reduction Applied” adjustment means?

I recently was contacted by an independent physician (POS 11), regarding an adjustment that states “Medicaid ATB Reduction Applied”. This was on his claims for the Managed Medicaid Plans. Please see below.

Managed Medicaid Plan EOB example

Back in early 2020, I warned NY providers that there will be NY State Medicaid reductions (due to COVID-19 Pandemic). My clients already knew to expect it. However, since this particular independent physician had an out-of-state billing services, he was not notified.

So, what does this mean?

ABT stands for across the board. So, the “Medicaid ATB Reduction Applied” means just that- the reduction in payment was applied.

Now it is helpful to mention that this particular independent physician does have an office and a fee for service contract with Managed Medicaid Plans. Not all services are subject to Medicaid ABT Reduction.

Please see below for the partial list of services that are exempt from this reduction:

Some of the services that are subject to this reductions are: (partial list)

NY Managed Care Plans and this includes HIV SNP plans)

Please note that initially NY Medicaid did institute a 1% reduction, effective DOS 01/01/2020 and beyond. However, as of 04/01/2020 that amount is now 1.5%. .

For more information about this and the complete lists of exempt/affected services, please click here to visit the NY Medicaid Website.

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s