According to a new study published in the New England Journal of Medicine, increasing Medicaid reimbursement for primary care services to match Medicare rates have led to increases in appointments for Medicaid patients. However, care access gains may be completely “wiped out” this year because the ACA’s provision authorizing the increase in Medicaid rates has expired. Researchers noticed an increase from 58.7% to 66.4% in the availability of primary care appointments for Medicaid beneficiaries in the surveyed areas. The increases in appointment availability were similar in states that expanded Medicaid coverage and in states that did not. With this newly available data, physicians hope the Medicaid pay bump will be extended. Average national Medicaid reimbursement to primary care physicians is expected to drop between 43% and 47% as a result of the provision ending.
The CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register on November 13, 2014. Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 in an effort to implement corrections to technical errors discovered after the publication of the MPFS rule. Please note, this hold will have a minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 days (29 days for paper claims) after the date of receipt. MPFS claims for services provided on or before Wednesday, December 31, 2014 are unaffected by the 2015 claims hold and will be processed and paid under the normal procedures and time frames.
Under the ACA, Medicaid has increased its payments to equal the 2013 and 2014 Medicare fee for certain primary codes when billed by an eligible primary care provider, who has submitted a valid attestation to the Department of Social Services. However, the ACA requirement ends with dates of service January 1, 2015 and forward.
The Connecticut General Assembly has appropriated funding within the Medicaid biennial in order to continue increased primary care payments for dates of service beyond December 31, 2014. The Department is establishing a policy for primary care increased payments; this policy will be referred to as the HUSKY Health Primary Care Increased Payments Policy. The Department is also revising the list of codes eligible for an increased payment.
Click here for more information from the Connecticut Department of Social Services regarding the HUSKY Health Primary Care Increased Payments Policy.
According to a new report by the Kaiser Family Foundation, Florida has the worst physician shortage in the country. Areas and population groups with a population-to-provider ratio of 3,500-to-one (or 3,000-to-one in areas of high need) are designed health professional shortage areas (HPSAs), according to experts. The Kaiser Family Foundation report found approximately 6,100 HPSAs nationwide. Florida has more than 252 primary care HPSA designations and meets less than 45 percent of the state’s overall need. Other states with high HPSAs include California, New York, Texas and Illinois. Is it important to note, however, that the report does not account for additional primary care that physician assistants or nurse practitioners could provide-two groups that are often suggested as a way to offset the shortage.
Last month, CMS issued the final rule that updates the payment policies and payment rates for services under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2015. The rule changes several of the quality reporting initiatives associated with PFS payments, including the Physician Quality Reporting System (PQRS).
The rule includes several changes for the 2015 PQRS program. Highlights include:
EPs and group practices that meet the criteria for 2015 PQRS reporting will avoid the negative payment adjustment in 2017
A total of 255 measures in 2015, including:
63 outcome-based measures
19 cross-cutting measures
Addition of two measures groups
Removal of five measures groups
Critical Access Hospitals Method II (CAH-II) may now report PQRS via claims
Note: There is no incentive for 2015 PQRS reporting.
In order to increase transparency, CMS has released new data giving consumers and researchers the tools and information they need to review 2015 health insurance plan information. New choices and more competition means that consumers will have even more affordable options during Open Enrollment this year. With 25 percent more issuers participating in the Marketplace this year, more than 90 percent of consumers will be able to choose from three or more issuers, up from 74 percent in 2014.