Wednesday, January 16, 2019

Don't Miss Out On Increased Medi-Cal Payments

The California Department of Health Care Services (DHCS) will soon be implementing rate increases for primary care physicians who treat Medi-Cal patients, as authorized under the Affordable Care Act. The increase also applies to services provided by physicians to Medi-Cal managed care patients. In order to see the bump in pay, providers must first attest to their eligibility. According to DHCS, less than half of eligible providers have completed the brief self-attestation process as of September 24. Have You?

For purposes of this regulation, primary care is defined as family medicine, general internal medicine, pediatric medicine or related pediatric subspecialties. Pediatric subspecialists must be recognized by the American Board of Medical Specialties, American Board of Physician Specialties or the American Osteopathic Association to receive the increased fees. If a physician is not board certified, eligibility can be determined by the physician’s billing history. Physicians will qualify if 60 percent of the codes they bill are for evaluation and management codes and vaccine administration codes covered by this rule. Physicians can self-attest to their board certification or billing history.

Although the regulations implementing the pay raise were released by the Centers for Medicare & Medicaid Services (CMS) in November 2012, DHCS is still awaiting approval of its State Plan Amendment, which details California's proposed payment methodology for both fee-for-service and managed care payments. DHCS expects to receive approval soon and plans to implement the increase in late October. Once approved, the increases will be retroactive to January 1, 2013.

The goal of the increase is to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the ACA. Under the ACA, primary care physicians will see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to CMS, states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contracting with Medi-Cal managed care plans see the higher rates.

Physicians are encouraged to complete the attestation form, which is available on the Medi-Cal website www.medi-cal.ca.gov. The attestation form must be completed online (paper copies will not be accepted).

The rate increase applies to evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461 and 90471 – 90474.

For more information on the increase, including which specialties qualify, see CMA’s Medi-Cal Primary Care Physician Rate Increase FAQs or contact RCMA’s Physician Advocate Mitzi Young at myoung@cmanet.org or (888) 236-0267.


California Health Benefits Exchange Opens

As Covered California, the state’s Health Benefit Exchange, opened today, California Medical Association (CMA) physicians remain optimistic. Throughout the health care reform debate, CMA strongly advocated for affordable access to care for California’s uninsured and for an expansion of health insurance coverage.

“CMA has long supported access to health care for all patients,” said Paul R. Phinney, M.D., CMA president. “Today marks a positive inflection point in our nation's commitment to access to health care for all Americans

Five categories of plans will be available through Covered California, consisting of four metal tiers (bronze, silver, gold and platinum) and a catastrophic plan. If offering a metal-tier health plan in Covered California, issuers also must offer the same plan at the same premium outside of the exchange marketplace.

“The opening of Covered California is an opportunity for patients who have gone without access to medical care for months, years or even decades to see a physician” added Dr. Phinney. “There is still work to do, since access to insurance does not always guarantee access to a physician. The doctors of CMA look forward to working with Covered California to ensure that all Californians have access to the care they need and deserve."

CMA, in conjunction with the CMA Foundation, the Latino Physicians of California and the American Academy of Pediatrics, California, was recently awarded a $1.5 million grant for outreach and education to physicians about Covered California. The focus of the grant is to educate physicians and their office staff about coverage eligibility and patient enrollment.

"We are on the ground, communicating with our member physicians and colleagues about Covered California," concluded Dr. Phinney. "We want to make sure physicians and their patients have the information they need to make the goals of Covered California a reality. As with any effort of this magnitude, there will be bumps along the road. We remain committed to the effort nonetheless, and will do our utmost to educate our partners and patients on the significance of this historic change in the delivery of health care."


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