The CMS on Friday released the list of primary-care sub-specialties that will receive higher Medicaid payment rates starting Jan. 1, 2013. Under the Patient Protection and Affordable Care Act, the federal government will reimburse states for raising Medicaid primary-care pay to Medicare levels. It was put in the law to ensure that the expected influx of new Medicaid enrollees can find doctors.
While the increase will differ by state, a recent survey by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute estimated primary-care physicians in Medicaid will receive a 73% average pay increase over the next two years. Physicians that qualify for the pay increases must be certified in any one of a number of internal, family or pediatric medicine sub-specialties and make 60% of their Medicaid claims using evaluation and management (E&M) and vaccination codes, according to the newly released guidelines. Physicians in other specialties who predominantly use those codes may also qualify for higher reimbursement.