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Good News! Medicare Payments Are Coming!

As part of the Patient Protection and Affordable Care Act (ACA), Medicaid payments for qualifying primary care services will be increased in calendar years 2013 and 2014 to the higher Medicare reimbursement rates. In Ohio, the Medicaid fee schedule in 2012 was 57% of Medicare, meaning an estimated overall fee increase of 76% in 2013 under the program, according to the Kaiser Commission on Medicaid and the Uninsured (KCMU)/Urban Institute Medicaid Physician Fee Survey. States will receive full funding from the federal government for the payment increase after the Center for Medicare and Medicaid Services (CMS) approves a State Plan Amendment (SPA). On June 21, 2013 Ohio's SPA was approved by CMS. In order for physicians to receive the higher reimbursement rates, they must submit a self-attestation which shows that they are eligible as a primary care provider according to the ACA guidelines. As of July 1, 2013, there were over 9,000 physicians in Ohio approved to receive the enhanced payments.

Approved physicians will start to receive the increased payment rates beginning July 1, 2013. The higher rates will be applied retroactively to claims processed between January 1, 2013 and June 30, 2013. In Ohio, processing of these adjustment will begin on June 15, 2013 and will be paid as lump sum payments. A physician's eligibility for retroactive payment is based on the date the self-attestation was submitted. Physicians who submitted an attestation between January 1, 2013 and May 1, 2013 will receive the higher rate for eligible services performed on or after January 1, 2013. If the attestation was submitted after May 1, 2013, the effective date will be the attestation submission date and the physician will receive higher rates for services provided on or after this date. Non-physician practitioners providing services incident to the eligible physician must bill under that physician in order to receive the enhanced payment amount.

Alta Partners will continue to provide updates to our clients and colleagues as new announcements are released.