Medicaid Rate Increase for Primary Care and VFC Administration Thank you for joining this live online broadcast of the Provider Overview of the Medicaid Rate Increase for Primary Care and VFC Administration. The meeting is scheduled to begin at 11:00 a.m. and conclude at 12:00 p.m. All attendees of the webinar will be in listen only mode for the duration of the broadcast. Please submit questions using the Questions box on the side of your screen. We will address as many as possible during the Question and Answer session at the end of the meeting. If you’re having difficulty hearing the meeting, please alert us by raising your hand using the icon and we’ll work to fix it as quickly as possible. Otherwise, please keep your hand down and use the Questions box to communicate with us.
Transcript
Medicaid Rate Increase for Primary Care and VFC Administration
Thank you for joining this live online broadcast of the ProviderOverview of the Medicaid Rate Increase for Primary Care and VFCAdministration. The meeting is scheduled to begin at 11:00 a.m. andconclude at 12:00 p.m. All attendees of the webinar will be in listenonly mode for the duration of the broadcast. Please submit questionsusing the Questions box on the side of your screen. We will address asmany as possible during the Question and Answer session at the end ofthe meeting.
If you’re having difficulty hearing the meeting, please alert us byraising your hand using the icon and we’ll work to fix it as quicklyas possible. Otherwise, please keep your hand down and use the Questions box to communicate with us.
Medicaid Rate Increase for Primary Care and VFC Administration
March 29, 2013
Maureen Regan Molly Marra
• Presentation and attestation form demo first
• Q & A following presentations
– Webinar participants: please use the chat feature on your webinar screen to ask questions
– If you’re having difficulty hearing the meeting, please alert us by raising your hand using the icon
Webinar Ground Rules
• Affordable Care Act (ACA) primary care fee increase
• MD implementation vs. other states – policy differences
• Eligible services
• Eligible and ineligible providers
• MCO Responsibilities
• Importance of attestation – claiming Federal funds
• Next steps – provider responsibilities
• Resources and staying informed
Overview
• What? – As part of the ACA, all States must reimburse certain primary care practitioners at 100% Medicare rates for certain evaluation and management (E&M) and vaccine codes
• Why? – To encourage greater participation in Medicaid heading into Health Reform
• When? – Effective for dates of services January 1, 2013 through December 31, 2014
• How? – Fee-for-service (FFS) Medicaid and managed care organizations (MCOs) will pay providers the increased rate as part of routine claims payment
ACA Primary Care Fee Increase
• Maryland is handling the Medicaid payment increase for E&M codes differently from every other state:o MD is paying the increased rate to most Medicaid providers who
bill for these important primary care services, including specialists and nurse practitioners.
o Providers will not have to attest before receiving the payment increase; however, Maryland still needs its primary care physicians to attest in order to claim federal funds.
• Maintain current methodology for billing Vaccines for Children (VFC) administration codes.
Maryland Implementation vs. Other States
Eligible Services
The following services are eligible for the increased rate:
•Current Procedural Terminology (CPT) E&M codes 99201 through 99499
o Maryland will pay the increased rate for previously covered codes within this range
•Vaccine Administrationo Providers in Maryland must continue to bill for VFC
administration using –SE modifiero Rate will increase to $23.28o Maryland will not reimburse for vaccine administration for adults,
maintaining current policy
Eligible ProvidersWhile Maryland Medicaid and MCOs will pay most providers billing eligible codes at the increased rate, Maryland can only claim enhanced federal matching dollars for physicians who meet the following criteria:
• Physicians with a specialty or subspecialty in family medicine, general internal medicine, or pediatric medicine; AND meet one of the following requirements:o Is Board certified as a specialist or subspecialist in family medicine,
general internal medicine, or pediatric medicine from a qualifying Board*; OR
o Attests that at least 60% of codes billed to Medicaid fee-for-service (FFS) and/or MCOs during last calendar year were for eligible E&M and/or VFC administration codes.
*As recognized by American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA) or American Board of Physician Specialties (ABPS)
Ineligible Providers
• The following providers are not eligible for the fee increase:o Providers who submit specialty mental health claims
through ValueOptions; o Out-of-network specialists (contact MCO to find out how to
join the network for higher rates);o Federally Qualified Health Centers (FQHCs);o Rural Health Clinics (RHCs); ando Tribal health centers.
MCO Responsibilities• MCOs are required to reimburse their panel providers, including in-network specialists, at least the 100% Medicare rate for eligible services.• MCOs are also required to pay the 100% Medicare rate for:
o Out-of-network primary care and self-referred providers delivering eligible services (e.g., school-based health centers, ER doctors) and o FQHCs providing services for Primary Adult Care (PAC) recipients.
• As necessary, the MCOs and the fee-for-service program will re-adjudicate provider claims for the increased E&M codes or VFC administration delivered between January 1 st, 2013 and mid-March to make sure providers receive the increased payment.
Complications with Increasing Rates
• BOTTOM LINE: Providers will receive increased rates for primary care services delivered on or after January 1, 2013 – FFS & MCOs will reprocess claims
• Complications along the way:– Typically, MD Medicaid rates not directly tied to Medicare– Delay due to “fiscal cliff” conversations in D.C.– MD finally received rates in mid-February 2013– Unfortunately, the federal contractor miscalculated rates– MD only received corrected rates in mid-March– FFS and MCOs are loading corrected rates by early April– FFS and MCOs will start paying increased rates in April and will
reprocess claims for services rendered January - March
Drawing Federal Matching FundsMaryland only receives enhanced federal funds for eligible providers who self-attest that they meet the conditions on the previous slide.
Provider Attestation•The Department developed an online attestation form for all eligible physicians – it’s quick and easy!
•Attestation will ensure the State receives Federal match on eligible services.
•Providers need to submit their attestation by April 15th.
•All primary care physicians, regardless of whether they bill MCOs and/or Medicaid fee-for-service, should use the Maryland online form.
•Providers need only self-attest once to receive the increase rate for services provided between January 1, 2013 and December 31, 2014.
Why should you complete the self-attestation form?
• Again, Maryland only receives enhanced federal funds for providers who complete this form.
• In order to make sure the program doesn't have to cut other rates or services, we need as many primary care physicians as possible to complete the online Provider Attestation by April 15th.
• Nurse Practitioners and physicians who practice a specialty other than family medicine, general internal medicine, or pediatric medicine do not need to complete the primary care attestation form in Maryland.
Next Steps for You
• Please complete the primary care self-attestation form online by April 15th.
• You can find the form at:– dhmh.maryland.gov/attest
• Please share this link with other primary care colleagues.
• It is OK for your office assistant to complete this form on your behalf.
• If you have more than 10 physicians in your practice and would like to complete an excel sheet with all information at once, please email [email protected]
DemonstrationPrimary Care Attestation
Form
Please wait while we open another screen
Resources and Staying Informed
If you would like to know more about the primary care fee
increase, here are a few additional resources:
• There is another webinar next week if you think other colleagues would like to attend:Wednesday, 4/3 from 10-11am: https://www4.gotomeeting.com/register/863138463
• Go to https://mmcp.dhmh.maryland.gov/SitePages/PCPFeeIncrease.aspx for:• Federal notices regarding ACA Section 1202
• Transmittal PT 17-13 re: PCP fee increase
• Physicians’ Services Fee Manual
• Physicians’ Fee Schedule
Additional Questions?
For additional information on the PCP Fee Increase in Maryland, please email:
