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Friday, November 2, 2012

New higher Medicaid rates on the way

Family medicine physicians can look forward to higher reimbursement checks next year when they take care of Medicaid patients.

The Centers for Medicare and Medicaid Services (CMS) on Nov. 1 announced final rules that will require that physicians providing certain primary care services to Medicaid patients get paid at the same rate as they do for treating Medicare patients beginning Jan. 1 and extending to the end of 2014. Medicaid, overseen by the individual states, typically reimburses at a lower rate than the federally operated Medicare program.

The change affects physicians in family medicine, general internal medicine, pediatricians, and related subspecialists, such as pediatric cardiologists. Certain other practitioners, such as nurse practitioners, may also receive the higher reimbursements if working under the direct supervision of a qualifying physician.

The higher payments apply only to evaluation and management services, not specific procedures or diagnostic testing. CMS officials said they will work with the states on the details of implementing the higher payments.

The provision was included in the Affordable Care Act of 2010. The federal government will reimburse states for the difference in cost based on their Medicaid rates as of July 1, 2009.

Other final rules released Thursday included changes in the Value-Based Payment Modifier Program, which will assign bonuses and penalties for physicians based on the quality and cost of care provided. The program will be phased in between 2015 and 2017 with the rules initially applying only to practices with 100 or more eligible professionals.

The original proposal was to start with physician practices of 25 or more professionals. In any event, the government still plans to apply the payment modifiers to all physicians by 2017. 

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