Provider Alert! Rural Hospitals Outpatient Ratio of Cost to Charges update

Provider Alert!

Provider Alert! Rural Hospitals Outpatient Ratio of Cost to Charges update

Date: September 20, 2021

Attention: Rural Hospitals

Effective Date: September 1, 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: The Health and Human Services Commission (HHSC) increased the Rural Hospitals Outpatient Ratio of Cost to Charges (RCC) effective for dates of service September 1, 2021 by 16% (the hospital RCC must not exceed 100%).

How this impacts providers: HHSC and Texas Medicaid and Healthcare Partnership (TMHP) are preparing to implement these changes.  The outpatient RCCs that will be posted on the HHSC website on or before September 15, 2021 will not include these increased ratios.  HHSC Provider Finance Department will send notification to TCHP once these ratios are increased. Providers will not have to submit corrected claims or appeals. Claims will be reprocessed with the appropriate Ratio of Cost to Charges (RCC).

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

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