MedicaidAdministrativeHigh impact
Newsletter Vol. 12, No. 42
New Jersey Medicaid·NJ·Provider Notice
Effective date
May 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey hospitals must immediately notify the Division of Medical Assistance & Health Services (DMAHS) of any significant changes to their charge structures or charge ratios used for Medicaid/NJ FamilyCare reimbursement. Failure to disclose changes may result in retroactive claim adjustments, cost-to-charge ratio reductions, and potential recovery of overpayments with interest, penalties, and criminal prosecution.
Action Required
REQUIREMENTS:
- Immediately: Billing team and hospital finance must review all charge structure changes made since the historical cost-to-charge ratio baseline. Document any modifications to charges in any care areas (particularly mental health services) or across multiple disciplines.
- Before any future charge structure changes: Hospital administrators must contact Jacqueline Cantlin, Administrator, Office of Provider Rate Setting, at (609) 588-2899 to notify DMAHS of significant changes and coordinate corrective action.
- If charge structure changes have already occurred: Contact DMAHS at (609) 588-2899 immediately for voluntary disclosure and corrective action coordination to avoid retroactive claim adjustments, reduced cost-to-charge ratios, interest charges, civil penalties, and criminal prosecution.
- Ensure all hospital outpatient charges are consistently related to actual costs of services and uniformly applied to all patients (inpatient and outpatient) per HCFA Provider Information Manual Publication 15-1 requirements.
- CONSEQUENCES: Hospitals that fail to coordinate corrective action and are found receiving excessive reimbursement face automatic retroactive claim adjustments to the date of change, cost-to-charge ratio reductions, recovery of overpayments, interest, civil penalties, and potential criminal prosecution.