ACA Medicaid fee increase for primary care services begins

Deadline to complete attestation for retroactive payment is April 1, 2014

posted 3.20.14

Medicaid HMOs in Texas began paying supplemental payments to physicians for primary care services provided in the first quarter of 2013 as called for in the Patient Protection and Affordable Care Act, so long as those physicians had successfully completed the attestation form available on the Texas Medicaid Health Partnership website by Oct. 16, 2013. Those HMOs will begin making supplemental payments for physicians who completed the form after that date in late April.

To be eligible for the increased fees, physicians must attest that they are board certified in a primary care specialty or that at least 60 percent of their total billings are for evaluation and management services and vaccine administration by completing the attestation form. To complete the form, you will need your National Provider Identifier, your Texas Provider Identifier, and a copy of your board certification if available.

Primary care physicians who complete the self-attestation form by April 1, 2014 will receive retroactive payment for claims back to the beginning of 2013. Physicians who complete the form after April 1, 2014 will only get increased fees back to the date of their attestation. TMHP recently posted a list of Frequently Asked Questions and Answers regarding the supplemental payments.

Under the ACA, physicians will only receive payment for the difference between what they were paid for services and the lesser of the Medicare allowable fee and what they billed.

> Access the attestation form, Texas Medicaid Attestation for ACA Primary Care Services Rate Increases
> Access the list of physicians who have submitted their attestation forms