Primary care physicians who are eligible for a significant, temporary Medicaid pay increase through the Affordable Care Act first must complete an attestation form on the ForwardHealth web portal. To date, about 1,200 physicians and advanced practice providers (APPs) have attested for the increased Medicaid reimbursement, however, the Department of Health Services (DHS) says many more are eligible.
The rate increases apply to certain evaluation and management (E/M) and vaccine administration services with dates of services from January 1, 2013, through December 31, 2014.
An eligible physician is one who specializes in general internal medicine, family medicine or general pediatrics or an included subspecialty as defined by the American Board of Medical Specialties (ABMS), American Board of Physician Specialties (ABPS) or American Osteopathic Academy (AOA) by fulfilling at least one of the following:
- Certification from an ABMS, ABPS or AOA member board
- 60 percent of services provided in the last calendar year (or prior month for newly eligible physicians) are billable under CPT codes 90460-90749 and 99201-99499
Reconciliation payments retroactive to January 1, 2013, should begin in October 2013 according to DHS, which is working with its fiscal and technical agent to implement real-time payment after reconciliation payments begin. Retroactive payments will be completed in attestation-date order. According to DHS, fee for service (FFS) physicians and APPs will receive reimbursement for the increased rate for each eligible patient per eligible code. Contracted HMO Medicaid providers will receive a quarterly reconciliation payment.
Additional information about eligibility and attestation is in this ForwardHealth Update. Click here to access the attestation form. DHS is expected to provide additional information related to the increased payments to attested physicians in the near future. Watch Medigram for updates.
Back to June 27, 2013 Medigram