Enhanced Physician Payment Reminder

 

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) increasing Medicaid reimbursements for evaluation and management and immunization services to 100 percent of Medicare reimbursement in 2013 and 2014. The increase applies to both fee­ for-service (FFS) and managed care organization (MCO) plans.

All providers participating with Medicaid FFS and those only participating with MCOs need to register with SCDHHS and complete the Primary Care Provider Attestation form in order to be eligible to receive the enhanced primary care reimbursement rates.

Due to slow provider attestation, SCDHHS has extended the enrollment period to allow greater opportunity for providers to enroll and receive retroactive payments. Therefore, all FFS and MCO providers registered on or before March 15, 2013, will receive enhanced reimbursement retroactive payments for claims submitted with a date of service back to January 1, 2013.

Examples:

  • If the Provider attests on March 15, 2013, and submits a claim on March 18, 2013, with a date of service of February 15, 2013, the Provider will receive the enhanced payment.
  • If the Provider attests on March 15, 2013, and has already submitted a claim on January 10, 2013, with a date of service of January 3, 2013, the Provider will receive the enhanced payment.
  • If the Provider attests on February 5, 2013, and has already submitted a claim on January 4, 2013, with a date of service of December 26,2012 the provider will not receive the enhanced payment.

 

All FFS and MCO providers that register after March 15, 2013 will only receive enhanced reimbursement payments on claims received after the completion of attestation with a date of service on or after the first of the month of attestation. Examples:

  • If the Provider attests on March 15, 2013, and submits a claim on March 17, 2013, with a date of service of March 2, 2013, the provider will receive the enhanced payment.
  • If the Provider attests on April 3, 2013, and submits a claim on April 4, 2013, with a date of service of March 31, 2013, the provider will not receive the enhanced payment
  • If the Provider attests on April 3, 2013, and submitted a claim on March 15, 2013, with a date of service of March 3, 2013, the provider will not receive the enhanced payment.

 

Providers are encouraged to attest as soon as possible to qualify for payments back to January 1, 2013.

The registration portal is available at: www.scdhhs.gov/physicianattestation

For more details on this implementation, including the bulletin released on January 8, 2013 and Questions and Answers, please visit the SCDHHS web site at www.scdhhs.gov.

This bulletin applies to fee-for-service, medical homes networks and MCOs. If you have any questions regarding this bulletin, please contact the Provider Service Center at (888) 289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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