Medicaid rule clarification expands eligibility for bonus

Monday, March 11, 2013 03:04 PM

All Medicaid providers should check to see if they are eligible to complete attestation to receive Medicaid bonus

posted March 11, 2013

Changes to Medicaid 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 Medicaid reimbursement to Medicare rates. A recent study shows that for many Colorado physicians this change would represent an estimated 32 percent fee increase on average.

The statute specifies that higher payment applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine. It also specifies that specialists and subspecialists within those designations as recognized by the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA) or the American Board of Physician Specialties (ABPS) also qualify for the enhanced payment. Under the regulation, “general internal medicine” encompasses internal medicine and all subspecialties recognized by the ABMS, ABPS and AOA. Click here for more information on covered specialties.

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, or as having a subspecialty within those specialties recognized by ABMS, ABPS and AOA. 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.