Primary Care Reimbursement Changes Under the Affordable Care Act
Find out what these federal changes mean for primary care practitioners who serve Maryland Medicaid participants.
As part of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) announced that physicians who meet their definition of primary care provider would receive increased Medicaid reimbursement. The purpose of this increase is to encourage greater participation in Medicaid heading into Health Reform. Maryland and other states will increase rates to 100% of the Medicare rates for eligible primary care services delivered by eligible primary care providers between January 1, 2013 and December 31, 2014. The increased rate is applicable to previously covered Evaluation and Management (E&M) codes 99201-99499 and Vaccine for Children (VFC) administration codes, billed using the –SE modifier.
Maryland's Unique Implementation of the Primary Care Physician Rate Increase
Maryland is handling the Medicaid payment increase for these important primary care services differently from every other state. The rates in Maryland apply to most Medicaid providers who bill for these services, including specialists and nurse practitioners. As always, Medicaid pays the lesser of the provider's usual and customary charge or the Physicians' Fee Schedule. Providers who submit specialty mental health claims through ValueOptions are excluded from the fee increase.
Medicaid fee-for service (FFS) and managed care organizations (MCOs) are implementing rate increases for eligible services. While Maryland Medicaid providers do not have to attest to receive the payment increase from the FFS program and/or MCOs, Maryland cannot draw down Federal funds unless primary care physicians submit the online Primary Care Attestation form
What Providers Need To DoTo ensure the program doesn't have to cut other rates or services, we need as many primary care physicians as possible to complete the online Primary Care Attestation form. Therefore, we strongly urge all physicians who practice in Family Medicaid, General Internal Medicine, and/or Pediatrics - even if you are not Board certified in those specialties - to complete the online form. It is QUICK, EASY, and SECURE! Look for it at the top of this page and on the DHMH homepage, too!
PCP Increase Clinician Letter from Secretary Sharfstein.pdf
Updated transmittal coming soon!
If you are an office manager with more than ten physicians, you may submit the form below via secure email to firstname.lastname@example.org
If you have any questions about the Primary Care Attestation form and/or the primary care reimbursement changes under the ACA, please email us at email@example.com