It’s Official: Primary Care Physicians Get Medicaid Reimbursement Boost

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Primary care physicians will soon be reimbursed at Medicare rates for treating Medicaid patients.

The US Department of Health and Human Services published new rules last week making official a proposal that has been in the works for months. The rate increase officially begins on Jan. 1, 2013, and will only be available for two years. Although reimbursement rates vary by state, the average increase across the nation will be around 50 percent.

As NPR recently reported, the increase in rates does not extend to the emergency room or OB/GYN nurses, despite efforts by those groups to be included.

The purpose of the boost in reimbursement rates is to encourage more primary care physicians to take on Medicaid patients, thereby improving their overall care. What follows is HHS’s summary of the new rules (the entire report can be downloaded below):

This final rule implements Medicaid payment for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor. This minimum payment level applies to specified primary care services furnished by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine, and also applies to services rendered by these provider types paid by Medicaid managed care plans contracted by states to provide the primary care services. It also provides for 100 percent federal financial participation (FFP) for any increase in payment above the amounts that would be due for these services under the provisions of the approved Medicaid state plan, as of July 1, 2009. In other words, there will not be any additional cost to states for payments above the amount required by the 2009 rate methodology. In this final rule, we specify which services and types of physicians qualify for the minimum payment level in CYs 2013 and 2014, and the method for calculating the payment amount and any increase for which increased federal funding is due.

In addition, this final rule will update the interim regional maximum fees that providers may charge for the administration of pediatric vaccines to federally vaccine-eligible children under the Pediatric Immunization Distribution Program, more commonly known as the Vaccines for Children (VFC) program.

Download the approved regulations and summarized comments below :

(You must be logged in to download this file. Don't have an account? Register for free and you'll be returned to this page.)
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Posted in Denials Management, Medical Receivables, Patient Experience, Patient Financial Services .

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