Monday, October 12, 2015

Primary Care Providers: Are You Feeling the Pinch?

It was nice while it lasted. Due to a provision of the Patient Protection and Affordable Care Act, services furnished by certain primary care providers were subject to an enhanced payment rate for calendar years 2013 and 2014. These PCPs had to have been (a) Board-certified in the specialty designation of family medicine, general internal medicine or pediatric medicine or have a subspecialty designation recognized by specific boards or associations, or (b) furnished more than 60% of claims in specific evaluation and management or vaccine administration services under certain codes to have been eligible for these enhanced payments [1].  The payments were raised to the level of the Medicare Part B fee schedule rate (unless the actual billed charge for the service was lower), and providers had until April 1, 2013 to self-attest to being eligible [2].  The increase applied to both fee-for-service and managed care Medicaid plans.