HNF Stories
11:26 pm
Thu May 30, 2013

It's Deadline Day for Doctors' Bonus

Primary-care physicians who treat Florida Medicaid patients are eligible for a big, fat retroactive bonus thanks to the Affordable Care Act -- as long as they file for it by Friday, May 31.

Doctor and patient

The amount of money at stake is considerable, particularly in Florida, as Health News Florida reported in December. The ACA raises the pay rate for Medicaid to the level of Medicare for two years, as a way to get more doctors interested in participating.

Nationwide, the average increase is about 73 percent, but Florida's pay rate for Medicaid is so low that matching the Medicare rate will more than double it.

Those who file by today will get a check retroactive to Jan. 1, and will continue to receive the higher pay through the end of 2014. Those who miss the deadline today can still sign up for the higher payments going forward; they'll just miss out on the retroactive bonus.

Florida's Agency for Health Care Administration has sent out seven notices to doctors reminding them to file for the funds. Agency officials said this week that 9,000 of the 13,000 eligible doctors have filed for the money, which means that 4,000 Florida doctors are leaving money on the table.

The difference in pay is considerable, as these examples released by AHCA show:

--An office visit for a new patient of moderate complexity that typically lasts 45 minutes would pay about $186 under the Affordable Care Act Primary Care Fee, more than double the usual Florida Medicaid payment of $68.

--A visit for an established patient of low complexity that typically lasts 15 minutes would pay $81 --three times the prior fee of about $27.

--Evaluation and management for a critically ill or injured patient during the first hour would pay $305 compared to the usual $142.

The ACA included the boost in Medicaid doctor pay to get more physicians involved in treating low-income patients at a time when their numbers will be increasing.  Even though the Florida Legislature turned down federal funds that would have expanded Medicaid to more than 1 million low-income adults who are not currently eligible, Medicaid is expected to take a big jump in enrollment. That's because there are hundreds of thousands of uninsured Floridians who qualify for Medicaid but have never signed up.

The need for doctors to treat these new patients will be urgent. As Kaiser Health News reported last August, a study in Health Affairs found that in 2011, one-third of doctors refused to accept Medicaid patients because of low pay.

To receive the pay bonus, doctors must file what is called an "attestation." The fastest way to do it is to go through this AHCA web portal.

To be eligible, physicians must be board-certified in a primary-care specialty -- family medicine, internal medicine, or pediatrics -- and perform the usual primary-care services, evaluating and treating new and continuing patients and providing vaccinations. More information on eligibility is at this website