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Archives for November 2012

Medicaid Rates to Increase to Medicare Levels for Primary Care Physicians with Speciality Designations

Beginning in January 2013, certain Medicaid payments to some primary care physicians will increase pursuant to a provision in the Affordable Care Act.  The rates will increase to the Medicare levels for 2013 and 2014.  According to CMS, “The payment increase applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists.”

Further, the increased payment will apply to applicable services provided by a practitioner working under the supervision of a qualifying physician.  The difference between the state’s Medicaid rate and the Medicare rate will be covered by 100 percent federal financial participation (FFP).  All physicians who fall within the specialty designations listed should proactively monitor payment rates beginning in 2013 to verify that the increase was properly implemented.

Jeyaram & Associates at Georgia Medical Group Management Association Conference

Thanks to everyone who stopped by our booth yesterday at the Georgia Medical Group Managers Association Conference at the Georgia Tech Hotel and Conference Center! The cake pops with the Jeyaram & Associate’s logo were a huge hit with everyone.




Click here to learn more about GMGMA

Medical Group Management Association: Governmental/Third Party Payer Forum This Friday

Stop by our booth this Friday, November 9th, at the Medical Group Management Association (MGMA) Governmental/Third Party Payer Forum to learn more about how Jeyaram & Associates can help medical practice managers with issues such as Medicaid and Medicare audits, reimbursement disputes, litigation and appeals and how Jeyaram & Associates can serve as your in-house counsel.

Office of Inspector General’s 2013 Work Plan Increases Focus on Hospital Billing and the Affordable Care Act

Last month the Office of Inspector General (“OIG”) released its Work Plan for Fiscal Year 2013 (“FY 2013 Work Plan”).  The FY 2013 Work Plan focuses on many of the same areas as the prior year; however, there are two areas that received extra attention:  hospital billing and payment issues and implementation of the Affordable Care Act (“ACA”).

For Medicare purposes, the OIG has added new reviews including:

  • the efficiency of edits to identify hospital claims that were billed as discharges when they should have been billed as transfers
  • costs resulting from inpatient hospital claims for canceled surgical procedures
  • savings resulting from new payments for swing-bed services at critical access hospitals

One area of increasing focus in the Medicaid arena is prescription drugs.  In FY 2013, the OIG intends to explore alternative payment methods for home blood-glucose test strips.  The cost-saving means include rebates and competitive bidding, both of which have been successful at reducing net payment rates in some states.

Finally, the OIG will continue to monitor the ongoing implementation of the ACA.  Actions that the OIG intends to take in FY 2013 include the following:

  • reviewing compliance of home health agencies with the ACA requirement that physicians or other certain practitioners have face-to-face contact with beneficiaries
  • exploring cost savings associated with rental rather than purchase of power mobility devices
  • planning the frequency of on-site visits as part of the Medicare enrollment or re-enrollment process

As the OIG begins to implement its FY 2013 Work Plan, providers should continue to monitor what Medicare and Medicaid areas receive increased attention.  Additionally, providers should be proactive as the deadlines approach for implementation of parts of the ACA.