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101. Mass. Code Regs. 614.08. - Reporting Requirements

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“Reporting Requirements”
This section establishes the reporting requirements to the Health Safety Net Office for providers, hospitals, community health centers, third party administrators, surcharge payers, and ambulatory surgical centers.  The Health Safety Net Office may revise and audit the data submitted. Among these reporting requirements for is hospitals may be required to submit interim data on revenues and costs to monitor compliance with federal upper limit and disproportionate share payment limits. Such data may include, but not be limited to, gross and net patient service revenue for Medicaid non-managed care, Medicaid managed care, and all payers combined; and total patient service expenses for all payers combined. Each hospital must submit a quarterly unmatched payer report. The Health Safety Net Office may deny payment for eligible services to any facility that fails to comply with the reporting requirements.A third party administrator surcharge payer that makes payments to hospitals and ambulatory surgical centers on behalf of one or more insurance carriers must file an annual report with the Health Safety Net Office. Any of these providers that fails to file data, statistics, schedules, or which falsifies same, shall be subject to a civil penalty.

Current as of June 2015