265.886 Denying Reimbursement Based on Volume of Procedures Performed:
MSSNY is asked to challenge the Department of Health (DOH) on the current lack of quality data as it reflects solely on currently defined low volume threshold; request that the DOH re-examine the policy and reverse its denial of reimbursement based on new quantifiable data gathered since the policy has been in place; and communicate to the DOH its concern with the nature of the policy, the appeals process and the denial of reimbursement to the physicians who contract with the Medicaid fee for service and managed care Medicaid programs. (HOD 2010-262; Reaffirmed HOD 2020)
