Medicare Compliance & Reimbursement

Find out how to self-attest to start collecting cash.

If you’re a primary care provider, you could qualify for extra Medicaid money from your state for E/M and vaccine services.  How much increase you eventually get will depend on the state you are in, but you must self-attest for starters.

Background: The Affordable Care Act requires state Medicaid programs to increase pay to primary care physicians in 2013 and 2014 to match Medicare rates for E/M and vaccine services, which means that most practices will see additional Medicaid income both years. The pay boost you’ll see will vary, but a Dec. 2012 Kaiser Family Foundation report stated that on average, Medicaid primary care fees will increase by 73 percent (www.kff.org/medicaid/upload/8398.pdf), although the specific amount will depend on your state.

Before you’ll see the pay raise, however, you’ll have to self-attest to your Medicaid provider(s) that you qualify as a board-certified family medicine, internal medicine, or pediatric medicine (or a subspecialty of these) provider or that at least 60 percent of your Medicaid claims for the prior year were for the codes described in the Affordable Care Act (E/M codes 99201-99499, and vaccine administration codes 90460-90461 and 90471- 90474).

Retroactive boost: Although the regulations went into effect on Jan. 1, many state Medicaid providers haven’t yet submitted implementation plans to the federal government. However, once their plans are approved by the U.S. government, the increased payment rate will be retroactive to Jan. 1.

Some states, such as California and Georgia, had not yet prepared self-attestation forms for you to complete at press time, but others, such as Colorado, are ready for you to begin self-attesting so you can collect your increased pay (www.colorado.gov/cs/Satellite/HCPF/HCPF/1197364127336).

Tips: You should fill out your state’s attestation form as soon as it’s available so you can start maximizing your payments. If you aren’t sure whether your state has begun the attestation process, contact your state Medicaid office and ask your state’s status and how you should attest that you qualify for the pay boost.

Sequestration Cuts Won’t Impact Medicaid

Effective April 1, assuming the government does not act in time to reverse the “sequestration” cuts, Medicare will face a two percent hit, as we outlined in MLR, v 39, number 6. However, you should keep in mind that Medicaid payments will remain unaffected by the pay reduction because Medicaid is exempt from the sequestration cuts.