CMS Releases Final Regulations

CMS recently released the final regulations governing the implementation of the Medicaid primary care rate increase to 2009 Medicare rates for calendar years 2013 and 2014. AMS has been working with Arkansas Medicaid to implement this program.

To qualify for the increased payment, the physician must meet one of the conditions listed below:

  1. 60 percent of claims billed to Arkansas Medicaid are E&M codes and/or vaccines administered under the Vaccines for Children program.
  2. The physician is board certified in one of the following specialties or sub-specialties:

There are other instances that specific sub-specialties such as cardiovascular disease management, gastroenterology, nephrology and geriatric medicine may qualify and information can be found here.

This website has three sets of FAQ that physicians may find helpful. To receive the increased payment, physicians must complete the self-attestation process. This process requires that physicians confirm their eligibility for increased payments by affirming that they meet one of the conditions listed above. The self-attestation process is available through the physician web portal or via paper form.

To attest online, visit the provider portal on the Arkansas Medicaid website.

To attest via paper form, contact the Arkansas Medicaid Provider Enrollment Unit at (501) 376-2211 (local or out-of-state) or at (800) 457-4454 (in-state).

No additional documentation is required at this time. However, random sampling will be completed to determine if the self-attestation requirements were actually met. If a physician cannot produce information to verify their eligibility for increased payments, all supplemental payments will be recouped.

Physician payments will be made on a quarterly basis. Arkansas Medicaid’s first payment to each physician will include all eligible claims with dates of service beginning January 1, 2013 through the current quarter. The supplemental payment will be listed in the “Financial Transactions” section of the Remittance Advice.