News: Medicaid Primary Care Incentive Payments

Medicaid Primary Care Incentive Payments Delayed, but will be Retroactive
MSNJ confirmed with DMAHS that the division will file the necessary State Plan Amendment (SPA) to obtain federal approval for the primary care incentive payments for fee-for service physicians. The SPA is due to the federal government by March 31st.  Once the State receives approval and increases the rates, retroactive payments (going back to January 1, 2013) will be made to physicians who qualify under the federal regulations. Read more. DMAHS is also working to ensure that physicians in MCOs will receive the primary care incentive payments retroactively. This implementation process is separate from the fee-for-service process. Read the separate article on steps that fee-for-service providers must take by March 15th to receive retroactive payments.

Medicaid Primary Care Incentive Payment Attestation: March 15th Deadline for FFS Physicians
CMS clarified that all physicians who qualify for the ACA enhanced payments to Medicaid primary care providers must complete an attestation form indicating board certification status in a primary care specialty. The deadline for submission of the ACA Self-Attestation Form for traditional fee-for-service Medicaid is March 15, 2013. An original signature is required; therefore the form must be mailed to: Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650. Fee for service physicians who do not  file the attestation form by March 15th will not receive the retroactive payments. Fee-for-service physicians are also being ” reminded of the importance of reporting their true usual and customary charges on these claims” to ” ensure that adjustment payments for eligible claims can be processed correctly.” Please see the DMAHS newsletter for details.

The fee-for-service deadline does not apply to physicians in the MCOs; a deadline will be provided in a letter to the physician from the MCO. The New Jersey Division of Medical Assistance and Health Services (DMAHS) explained that physicians may have to complete separate attestation forms for the Medicaid Managed Care Organizations (MCOs), if the MCO does not have a record of board certification on file. DMAHS is working with the MCOs to coordinate an outreach effort to the physicians that will need to provide an attestation. MSNJ will continue to communicate with the Medicaid program about MCO attestation requirements and retroactive payments. Please stay tuned to e-News for more information as it becomes available.


About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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