AAFP Checklist Helps Family Physicians Apply for Higher Medicaid Rate

July 31, 2013 11:39 am News Staff

The AAFP has put together a one-page checklist(1 page PDF) to help family physicians who treat Medicaid patients receive a higher payment rate as called for by a provision in the health care reform law designed to pay FPs and other primary care physicians at a rate at least equal to Medicare payment rates for 2013 and 2014.

[Parity-scale with coins on one end and dollar sign on the other]

The checklist will help family physicians self-attest for the program and is provided as part of an updated Web page on the Medicaid-Medicare parity provision. It lists eight steps in the attestation process and gives a brief description of each step to help family physicians meet the reporting requirements for attestation in their respective states.

To qualify for the higher payment rate, physicians trained in the specialty categories of family medicine, general internal medicine or pediatrics are required to self-attest that

  • 60 percent of all Medicaid services they bill or provide in a managed care environment are for specified evaluation and management (E/M) codes or vaccine administration codes, or
  • they are board-certified in one of the primary care specialties.

The increased payment, enacted as part of the Patient Protection and Affordable Care Act, will bring Medicaid payment rates for certain primary care services at least in line with Medicare levels for 2013 and 2014. These services are defined as those billed using specific E/M codes, as well as some codes for vaccine administration.

The provision officially took effect on Jan. 1, but a combination of factors delayed actual implementation. However, states are responsible for paying physicians retroactively to Jan. 1 if those physicians attest to their eligibility for the increased payments by a certain date, which varies by state.

The checklist advises family physicians to check deadlines carefully, particularly as specific attestation deadlines vary from state to state. "Most states will have a deadline date by which you must attest in order to receive a retroactive parity payment from Jan. 1, 2013," the checklist says. "If you miss this date and submit a form after this deadline, most physicians will receive parity payment retroactive to the date of their attestation submission only. Check your state Medicaid website for this specific information."

In addition, the checklist urges family physicians to verify that their attestation form was received by the state and to check with the state on when to expect payment. The checklist also advises family physicians to monitor their payments after submitting the attestation form.

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