Medicaid Primary Care Payment Error

Physicians who have attested to participate in the “enhanced” Medicaid primary care payment project may have received a lessor amount than was expected due to an error in processing. The ACA contained a provision requiring state Medicaid programs to increase payments to primary care physicians for primary care services to at least Medicare rates for 2013 and 2014, representing approximately a 25 percent increase for Arkansas physicians. Arkansas Medicaid is implementing the increase as a quarterly supplemental payment.

Several codes including immunizations were omitted from the first payment covering services billed during the first quarter of 2013. Physicians who contacted the Arkansas Medical Society reported that the amount they received appeared to be about one-half what they were expecting. The Society has been in close contact with Medicaid and HP regarding this issue. As a result, HP has made corrections in the process and will automatically calculate a supplemental payment expected to be sent to physicians within the next two weeks. Qualifying physicians should be receiving the second quarter enhanced payment by the first week of August.

The Arkansas Medical Society will continue to monitor this situation to ensure that the proper payment is made. Physicians should also take note that the enhanced payments continue to be limited to the lesser of the enhanced rate or billed charges. Since there are a few procedure codes used exclusively by Medicaid, specifically vaccine administration codes, physicians may need to update their billed charges to reflect what the practice bills other payers for a similar service.