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Enhanced Pay for Family Docs Due Jan. 1 Will Be Retroactive

State Medicaid programs have until March 31 to submit plans for implementing parity provision

WEDNESDAY, Jan. 16 (HealthDay News) -- Family physicians who see Medicaid patients and are entitled to enhanced payment will get their pay, although it is likely to be delayed.

Noting that specific physicians are eligible for enhanced payment under the parity provision of the Patient Protection and Affordable Care Act, which officially went into effect on Jan. 1, the Centers for Medicare & Medicaid Services (CMS) has produced a series of reports to address issues relating to implementation of the provision.

States are required to submit a state plan outlining how they intend to implement the parity provision by March 31. The CMS then has 90 days to approve or disapprove the plan, or ask for more information. States will be responsible for paying physicians retroactively. To qualify for enhanced payment, physicians have to self-attest that they are board-certified in family medicine, internal medicine, or pediatrics, and demonstrate that primary care services account for at least 60 percent of their billing related to evaluation and management codes.

"This is one part of the Affordable Care Act that helps primary care practices, improves payment rates, and increases access to health care for the underserved," Jeff Cain, M.D., president of the American Academy of Family Physicians (AAFP), said in a statement. "These are priorities for the AAFP."

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