Pediatric Coding Alert

Don’t worry if you haven’t seen pay raises yet—they’ll be retroactive.

Getting a payment increase from Medicaid sounds quite appealing to most pediatricians, but don’t forget to do your part to ensure that you’ll see a rise in Medicaid payments for E/M and vaccine services this year. Follow a few quick steps to confirm that you’ll get the raise.

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) in 2013, 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 pediatric medicine, family medicine, internal 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 increase 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, 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. To sustain the increased payment beyond 2014, it will be important that Medicaid patients experience improved access to care.