So here it is…seven months since physicians were promised
an increase in the Medicaid reimbursement…..and nothing. But…physicians have
seen an increase in Medicaid patients, and still are receiving the lower
Medicaid reimbursement! I might remind you that this Medicaid pay rate does not
even come close to covering the physicians cost! And it will only get worse!
Obamacare's 73% Medicaid Pay Raise For Doctors Is Delayed
3/15/2013 @
8:43AM Forbes
Bruce
Japsen, Contributor
A huge pay raise promised under the
Affordable Care Act for primary care doctors who treat the nation’s poor
covered by Medicaid health insurance is nearly three months behind schedule and
may take another three months before it kicks in, state Medicaid directors say.
Under the health law, a primary care
doctor – a family physician, a pediatrician or an internist – who treats a Medicaid
patient will see their reimbursement rise to the level of the Medicare health
insurance program for the elderly for scores of primary care services.
Doctors do have to apply to their state Medicaid programs and meet certain
criteria in part proving that they have historically treated certain numbers of
Medicaid patients.
Though the pay increase will vary
because Medicaid rates differ from state to state, the average pay increase
will be about
73 percent given Medicare last year paid on average 66 percent of
what Medicare pays for certain primary care services,
according to a Henry J. Kaiser Family Foundation study.
Doctors in some states could see payment increases of 100 percent or more.
The idea behind the pay increase, which
is funded by federal dollars for two years, is to get more doctors to accept
Medicaid patients and prevent other physicians from dropping out of a government
program that hasn’t been well funded. Amid a primary care doctor
shortage, eligible patients will need all of the doctors they can get given the
health law expands Medicaid coverage to millions more Americans effective Jan.
1, 2014 for participating states.
Because Medicaid is funded via a match
of funds from states and the federal government, cash-strapped states that have
cut from their programs in also lost federal dollars, allowing payment rates to
fall far behind.
“The purpose of the increase in Medicaid
physician fees for primary care is to encourage greater Medicaid participation
among physicians as the program expands in 2014 and demand for care increases,”
the
Kaiser report said. “If the enhanced payment rates succeed in
increasing physician participation and beneficiary access as intended, interest
in extending the higher Medicaid rates beyond 2014 is likely to be high.”
But the Obama administration says the
checks will eventually reach doctors and payments will be retroactive to Jan. 1
of this year so physicians who are approved to participate in their states will
get what they are due.
“The Medicaid enhanced payments for
primary care physician fee was made possible by the Affordable Care Act and is
in full effect for calendar years 2013 and 2014,” a spokesman for the Centers
for Medicare & Medicaid Services says. “States are moving quickly to
implement the higher payment and a number of states have already submitted
State Plan Amendments (SPAs) which will permit federal funding to flow to
states for the increases. In addition to submitting the required SPAs,
states are also in the process of reprogramming their claims processing systems
to pay at the appropriate, higher rates. CMS has made it very clear that
states must make enhanced payments to eligible providers retroactive to January
1, 2013.”
Exactly how federal dollars will be
doled out to doctors is unclear in part because an increasing number of states
in recent years don’t pay physicians on a fee-for-service basis.
Many doctors are paid bundled rates by
health plans like Humana (HUM), Amerigroup,
a subsidiary of Wellpoint (WLP), Aetna
(AET) or UnitedHealth Group (UNH) or physicians may
be employees and are therefore paid through their clinic, practice or other
entity, complicating the rollout of the pay increase. Therefore, the
payments for services aren’t necessarily apples to apples comparison when it
comes to paying the same as Medicare rates.
“How you do this in a managed care
environment is the big challenge,” Matt Solo, executive director of the
National Association of Medicaid Directors said in an interview.
“It is not at all clear.”
Solo estimates the money might not
reach doctors until late in the second quarter of this year, which would be by
June 30.
“The money will flow,” Solo said. “It
will eventually flow.”
Meanwhile, doctor groups wait patiently
for their funds.
“It is vital that Medicaid receive
sufficient funding to support an adequate network of caring physicians and
maintain its purpose as a social safety net,” said Dr. Jeremy A. Lazarus, AMA
president. “New federal funds authorized for primary care payment increases by
the Affordable Care Act are an important step in the right direction to
encourage more physician participation in the Medicaid program. The AMA and
other physician organizations have urged state Medicaid programs and governors
to move forward with filing the necessary paperwork with the federal government
so that increased Medicaid payments can be paid to eligible primary care
physicians.”
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