2013 Credentialing & Reimbursement Updates – Important!Medicaid Primary Care Payment Increase

The Affordable Care Act (ACA) enacted changes to Medicaid primary care reimbursement. Eligible physicians will receive supplemental payments for services rendered between January 1, 2013 and December 31, 2014. These supplemental payments will raise the Medicaid reimbursement to Medicare rates. To be eligible for the supplemental payments, physicians must self-attest as having a specialty in family medicine, general internal medicine, and/or pediatric medicine. Only physicians can complete the attestation! Staff or other representatives are not allowed to complete the attestation on the provider’s behalf. Click here to complete provider attestation.

Beginning in 2013, providers applying for initial credentialing or re-credentialing must submit a Certificate of CME Credit, which is received after completion of the opioid educational webinar. The webinar can be viewed by going to Pinnacol’s website.

Medicare Electronic Prescribing (eRx) Incentive Program

Those practices that did not meet the reporting criteria established for avoiding the 2013 eRx payment adjustment, or request a hardship exemption by July 2012, are subject to a 1.5% reduction in reimbursement in 2013.

Good news for practices that did not meet the reporting criteria: CMS has re-opened the Quality Communication Support Page, as of November 1, 2012, to allow individual professionals an additional exemption for the 2013 eRx payment adjustment!

What you need to do by January 31, 2013 to avoid the payment adjustment:

Submit a hardship Exemption Request via the Community Support Page –

  • Hardship exemptions include: Demonstrate the intent to participate in the EHR Incentive Program and adoption of Certified EHR Technology by registering for the EHR Incentive Program. Participants in the EHR Incentive Program must provide their entire EHR Certification Number to receive this hardship exemption.
    • Physicians who are unable to prescribe due to state, federal or local law;
    • Physicians with fewer than 100 prescriptions between 1/1/12 and 6/30/12;
    • Physicians in rural areas without sufficient high-speed internet access; or
    • Physicians in areas without enough pharmacies available for e-prescribing.
  • Meet the reporting criteria:
    • Report the eRx measure for at least 25 denominator-eligible visits from January 1, 2011 through December 31, 2011
    • Report the eRx measure’s numerator (G8553) on claims for at least 10 billable Part B Physician Fee Schedule services from January 1, 2012 through June 30, 2012.

Medicare Provider Revalidations

Medicare is continuing their efforts to re-validate ALL Medicare providers! There is 2 years left in their intended time frame.

You will be receiving a notification letter (letters being mailed between late 2011 & March 2015). You (the provider) only have 60 days to complete and submit the proper forms that must be completed. The process is/was to be suspended until after completion of the new MAC transition. However, if you do/ did receive a revalidation notice, don’t ignore it! PTANs will be deactivated if forms are not received and processed.

Provider credentialing has become increasingly complex! RT Welter offers credentialing and reimbursement management services to support every practice’s needs! Call or email us today for more information!