Colorado Medical Society

HCFP: Enhanced primary care rates now available

Monday, April 20, 2015 08:20 AM

Effectively immediately, the enhanced payment rates for evaluation and management (E&M) and vaccination codes for Medicaid beneficiaries are available and the difference for all claims submitted since Jan. 1 will be retroactively paid, the Colorado Department of Health Care Policy and Financing announced.

It was announced last year that Colorado Medicaid will reimburse covered office visit (E&M) and vaccine administration procedure codes at a rate equal to 100 percent of the December 2014 Medicare reimbursement rate from Jan. 1, 2015 to June 30, 2016. This adjustment was previously delayed as HCFP awaited approval by the Centers for Medicare and Medicaid Services before being able to load the enhanced rates into their claims processing system.

The new rates are now available to all enrolled providers who submit fee schedule claims for office visits or vaccine administrations; providers are not required to attest to providing primary care.

As promised in a bulletin in January, HCPF’s fiscal agent will mass adjust all qualified claims paid since Jan. 1 and repay them at the higher rates. Due to a limit on how many mass adjustments can be processed at a time, this process will take place over the next few weeks until all providers have been “made whole” for claims submitted since Jan. 1.

Please note that, although Medicare rates may be adjusted on a quarterly basis, Colorado Medicaid rates will not be adjusted to match these changes and payment will remain at the December 2014 level. HCFP will update providers if the rate benchmark changes.

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