Medicaid Primary Care Payment Increase: Attestation Required

Changes to Medicaid primary care reimbursement were enacted as part of the Affordable Care Act (ACA). Eligible physicians will receive supplemental payments for services rendered between Jan. 1, 2013, and Dec. 31, 2014, that raise the Medicaid reimbursement to Medicare rates. A recent study shows that for many Colorado physicians this change would represent an estimated 32% fee increase on average. To be eligible for the supplemental payment, physicians must self-attest as having a specialty in family medicine, general internal medicine, and/or pediatric medicine. Only physicians can complete this form (staff or other representatives are not allowed).

Make sure that you are eligible for these increased payments by visiting the Colorado Department of Health Care Policy and Financing attestation page here. Learn more about ACA enhanced payments for Medicaid primary care physicians here.

The 27 percent negative update to the Medicare Physician Fee Schedule will take effect on Jan. 1, 2013, unless Congress acts to avert the cut. Medicare claims for services rendered on or before Dec. 31, 2012, are unaffected and will be processed and paid under normal procedures and time frames.

Contrary to years past, physicians have been advised to continue submitting 2013 claims. These claims will be date stamped and paid in the order received, oldest first. Because clean electronic claims are not paid sooner than 14 calendar days after the date of receipt and paper claims are not paid sooner than 29 days, Congress has until Jan. 11, 2013, to act without substantial repercussions.

Should Congress step in within the 14-day window, Novitas Solutions, Inc., Colorado's Medicare contractor, has assured the Colorado Medical Society that there will be little-to-no interruption in cash flow as long as physicians continue to submit claims normally.

The Centers for Medicare and Medicaid Services said in an electronic bulletin that they are "disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk." They continue to urge Congress to take action, but must take steps to implement the negative update.

Federal CMS and the Colorado Medical Society will provide more information on or before Jan. 11, 2013. Stay tuned.

If physicians believe they meet one of the Medicare electronic prescribing (e-prescribing) hardship exemptions but did not file by the June 30, 2012 deadline, they will have another opportunity to apply.

The Centers for Medicare and Medicaid Services has reopened the Communications Support webpage to give physicians more time to file for a hardship, allowing more physicians to avoid the e-prescribing penalty. Available hardship exemptions include physicians:

1. unable to e-prescribe due to state, federal or local law/regulation;
2. with fewer than 100 prescriptions between Jan. 1 and June 30, 2012;
3. in rural areas without sufficient high-speed Internet access; or
4. in areas without enough pharmacies available for e-prescribing.

Many of the e-prescribing penalties received in 2012 by physicians who filed for a hardship exemption were due to filing errors. Therefore, it is important to know that hardships should be filed using the physician's individual Type I NPI. That is, the rendering Provider NPI used for box 24(J) of CMS 1500 form, or the NPI used in the Rendering Provider Name loop or the Billing Provider Name loop, if the billing provider and rendering provider are the same on the 837 (electronic claim) and the Tax ID number (TIN) they use to bill. Physicians who bill using their Employer Identifier number (EIN) should use their EIN for filing a hardship and those who bill using their Social Security Number (SSN) should use their SSN for filing hardship.

Please visit www.CMS.gov/ERxIncentive for additional information and resources. If you have questions regarding the e-prescribing program or need assistance submitting a hardship exemption request, please contact the AMA's QualityNet Help Desk at [email protected] or at 1-866-288-8912 (TTY 1-877-715-6222). They are available Monday through Friday from 8 a.m. to 8 p.m. MST. Physicians who are Mac users may still experience trouble filing for a hardship; if this occurs they should contact the Help Desk as well since the Centers for Medicare and Medicaid Services is still working to resolve these issues.

The State of Colorado will soon make a decision about whether or not to expand Medicaid based on the Supreme Court's ruling on the Affordable Care Act. The Colorado Medical Society has been polling our membership and working on an advocacy position over the past four months. The CMS Council on Legislation and the Committee on Physician Practice Evolution developed a recommendation that will be acted upon by the CMS board of directors during their Jan. 18, 2013, meeting. We want to know what you think about this position.

You should have received a brief survey in your e-mail from [email protected]. The survey is still open and we strongly encourage you to complete it. Results will be shared in aggregate with the CMS board of directors at the Jan. 18 meeting.

Because the link is unique, you will need to locate the original e-mail. If you have difficulty locating the e-mail, please contact us at [email protected].

Thank you in advance for giving us your insights. Best wishes for a safe and joyous holiday season.