For a summary of information related to enhanced rates for Primary Care Services:


Primary Care Provider Enhanced Fee Attestation

Pursuant to federal law the AHCCCS Administration will be increasing reimbursement for primary care services furnished by or under the personal supervision of certain physicians for dates of service January 1, 2013 through December 31, 2014. The increased payments are required by Sections 1902(a) (13), 1902 (jj), 1905 (dd) and 1932(f) of the Social Security Act and federal regulations in 42 CFR Parts 438, 441, and 447. These regulations are described in the final rule published in 77 Federal Register 66670 on November 6, 2012.

The increased payments are mandated by Section 1202 of the Affordable Care Act (ACA) which requires Medicaid programs to pay fees to designated physicians that are no less than the Medicare fee schedule in effect for 2013 and 2014 or the fee schedule rate that would result from applying the 2009 Medicare physician fee schedule conversion factor to the 2013 or 2014 Medicare payment rates, whichever is greater. The increased payment requirements apply to primary care and vaccine administration services described by the following codes:

  • Current Procedural Terminology (CPT) Evaluation and Management (E&M) Codes 99201 through 99499, and

  • Current Procedural Terminology (CPT) vaccine administration codes 90460, 90461, 90471, 90472, 90473, 90474 or their successor codes.

Increased payment rates may apply to nurse practitioners (NP) and physician assistants (PA) when they practice under the supervision of a qualified physician.

Physicians who meet the criteria below must complete the online Attestation form to receive enhanced reimbursement.

  • Criteria For Qualification:

  • Increases in reimbursement are limited to physicians who attest that they are either:

  • 1) Board certified with a specialty designation of family medicine, general internal medicine, or pediatric medicine, or a subspecialty of family medicine, general internal medicine, or pediatric medicine recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties ( refer to the application form) or

  • 2) A primary care physician or subspecialist who works in one or more of the above specialty designations but who does not have a certification specified in 1 but has billed at least 60% of Medicaid services provided, using the E&M and vaccine administration codes list above, during calendar year 2012. For newly eligible physicians, the 60% billing requirement will apply to Medicaid claims for the prior month. For eligible physicians who register as AHCCCS providers in CY13 or CY14, the 60% billing requirement will apply to Medicaid claims for the prior month using the E&M and vaccine administration codes listed above.

Recent CMS clarification

We have recently received further guidance from CMS (Center for Medicare & Medicaid Services) regarding the provider qualifications for primary care service enhanced payments. In order to qualify for the enhanced reimbursement, providers must attest as being board certified (as outlined above) by providing the begin date and the end date (or renewal date) of the board certification.

PCP Board Certifications for Enhanced Payments– Deadline Extension
For those providers who received a request to submit a copy of their board certification, the deadline for submission has been extended to July 31, 2013.

In addition, CMS recently received information from the American Board of Medical Specialties (ABMS) attesting that the American Board of Allergy and Immunology (ABAI) is an ABMS-recognized sub-discipline of the American Board of Pediatrics and the American Board of Internal Medicine, making their board certification eligible for enhanced payments. As with all other board certifications, the certification from ABAI must be current to qualify for enhanced payments.

If you fall into this category, please complete Certification and Attestation for PC Rate Increase Form A and Revised Primary Care Physician Certification form or Form B and fax to Provider Registration at 602-256-1474.

Online Attestation:

After reviewing the instructions below - follow this link to the AHCCCS Online website

NOTE: If you are unable to attest online, please email OIGProvider@azahcccs.gov to request paper forms.

 

Online Attestation for a Physician (MD) and/or Osteopath (DO):

  • Once a physician is logged in to his/her master AHCCCS Online account a "click here" link to attest will be displayed on the main page.
  • The link will direct the physician to the "Primary Care Physicians’ Certification and Attestation for Primary Care Rate Increase Form" (form A).
  • The physician will need to review and complete all applicable sections, to attest.
  • Once attestation is complete the physician should receive the following message:

Attestation Confirmation Message

  • Below the message is a summary of the information the physician selected/inputted, the information displayed is for the Physicians’ review.

All corrections/changes, after attestation, will need to be sent to
OIGProvider@azahcccs.gov, and may be required to complete additional forms

  • The physician will receive notification, at its current correspondence address, confirming the attestation was applied to its provider ID number within 10 business days.


For a physician who has attested and wants to include PAs or NPs under his/her supervision the Supplemental Form B must be completed for each NP and PA. To complete the Supplemental Form B:

  • Click "Add PA/NP" button.
  • The physician will need to review and complete applicable sections, to attest for a PA/NP.
  • Once attestation is complete the PA/NP, the PA/NP’s Name, Provider ID, NPI, Start date and End date (if applicable) will appear.

All corrections/changes, after attestation, will need to be sent to
OIGProvider@azahcccs.gov, and may be required to complete additional forms

  • The PA/NP will receive notification, at its current correspondence address, confirming the attestation was applied to its provider ID number within 10 business days.