DHCS pays over $100 million to primary care physicians in initial retroactive Medi-Cal rate increase payment February 7, 2014 Medi-Cal Affordable Care Act, Insurance/Reimbursement, Medi-Cal, ACA 0 The Department of Health Care Services (DHCS) has now made several retroactive interim payments to primary care physicians who have attested to their eligibility for the rate increases called for under the Affordable Care Act (ACA). These primary care payment increases have been put in place by the federal government in an effort to recruit more primary care physicians to treat low-income patients who will be newly eligible for health coverage in 2014. Although under the ACA the rate increases took effect on January 1, 2013, DHCS had been waiting for approval of its rate increase implementation plan from the Centers for Medicare and Medicaid Services (CMS). Approval was granted in late October, with the increases retroactive to January 1, 2013. These payments, totaling over $100 million, are an estimate of what DHCS believed is owed to physicians for fee-for-service Medi-Cal claims retroactive to January 1. The payments did not, however, include claim level detail. DHCS is also making weekly lump sum payments, in addition to regular Medi-Cal payments, to primary care physicians enrolled in fee-for-service Medi-Cal who have attested. The weekly interim payments represent estimated increase amounts due until DHCS’s computer systems can be updated to begin processing individual claims at the new rates, which could be as late as July 2014. Going forward, DHCS will make retroactive fee-for-service Medi-Cal claims payments on a monthly basis to physicians who have newly attested the previous month. When DHCS updates its computer systems and begins paying claims at the new rates, it will issue a final settlement, which will reflect a “true up” of payment owed but not reimbursed, or possibly a refund request if overpaid. This final settlement will include claim level detail for the entire amount paid as part of this increase. Attest today! The increased payments are not automatic. To qualify for the increased payments, providers must first attest to their eligibility. The attestation form is available on the Medi-Cal website. Physicians are required to complete the attestation online (paper copies will not be accepted). As of early January, DHCS reports that approximately 15,000 eligible providers have completed the attestation process. (For more information on the specialists and subspecialists that qualify, click here or see the CMS Q&A.) The increase also applies to services provided by physicians to Medi-Cal managed care patients; however, funding to the Medi-Cal managed care plans for the increase was not expected until the end of January. It is unclear exactly when each plan will make the retroactive payments or implement the increase once the federal funds are received. The California Medical Association (CMA) encourages practices to track all of the estimated lump sum payments received from DHCS, identified with RAD code 1801 (1801 A/R ACA interim payment). This upfront step should ease the reconciliation of those affected accounts once DHCS releases the claim level detail. The rate increase applies to evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461 and 90471 – 90474. More information on the primary care rate increase can also be found in CMA’s Medi-Cal Primary Care Physician Rate Increase FAQs. Comments are closed.
