I. Enhanced Physician Payments for RHC and FQHC Individual Providers II. Enhanced Physician Payments for all Providers

 

Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented the Affordable Care Act (ACA) final rule, 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.

I. Enhanced Physician Payments for RHC and FQHC Individual Providers

 

SCDHHS released an initial bulletin January 8, 2013 on the ACA Increased Primary Care Service Payment program.  This advised Federally Qualified Health Clinic (FQHC) and Rural Health Clinic (RHC) providers that enhanced physician payments did not apply to their provider type because the encounter rate is inclusive of evaluation and management services.  In a recent communication from the Centers for Medicare and Medicaid Services (CMS), clarification was provided on services that are rendered outside of the clinic where a physician who works for a FQHC or RHC could participate and receive enhanced reimbursements.  

The final revised regulation specifies that services provided under the physician benefit and billed using a physician fee schedule are eligible for the higher payment.  Since SCDHHS reimburses inpatient and outpatient hospital services on a fee for service basis, claims are also eligible for enhanced payments, but only if the physician who provides the services properly self attests to eligibility.  However, services provided by the physician in the FQHC and/or RHC settings are already reimbursed through the all-inclusive rate and would not be eligible for the enhanced rate.

The claims that would qualify for inclusion would be those claims that are filed by a FQHC utilizing their “CBP” provider number and the RHC utilizing their “GP” provider number as prescribed in policy.  Providers are encouraged to review the bulletin issued on January 8, 2013, for detailed instructions on the attestation process and the bulletin issued on February 26, 2013, providing additional instruction on attestation rules.  The links are:  

https://www.scdhhs.gov/sites/default/files/Enhanced%20Phys%20Payments112013.pdf

 https://www.scdhhs.gov/sites/default/files/Enhanced%20Physician%20Payment%20Reminder.pdf.

 

II. Enhanced Physician Payments for all Provider Types

SCDHHS has extended the enrollment period to allow FQHCs and RHCs individual providers who qualify to attest and receive enhanced payment.  All FFS and MCO providers registered on or before April 19, 2013, will receive enhanced reimbursement retroactive payments for claims submitted with a date of service back to January 1, 2013.  Providers will receive an adjusted payment on the remittance advice dated May 17, 2013, for claims processed through April 19, 2013.  The enhanced payment for claims with date of service April 20, 2013 or after will process via the regular claims processing schedule.  Providers are encouraged to attest as soon as possible to qualify for payments back to January 1, 2013. 

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.

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

For more details on this implementation, including the bulletins and Questions and Answers, please visit the SCDHHS web site at www.scdhhs.gov.  

This bulletin applies to fee-for-service, Medical Homes Networks (MHNs) 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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