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Practice Advocacy
Supporting PAFP Member Practices in their Dealings with Health Plans
PAFP Practice Advocacy Resource Service
The PAFP is dedicated to helping members and office administrators/managers with issues and concerns confronting their practices.
Tracy Koval, Director of Medical Practice Advocacy, leads PAFP practice advocacy efforts supported by Charles Artz, Esq. (PAFP Legal Counsel) and Brent Ennis, Vice President of Practice Advocacy & Government Affairs. Members may contact Tracy at 1 (800) 648-5623 or tkoval@pafp.com.
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HOW CAN I GET INVOLVED?
Practice Advocacy Commission
Join our Practice Advocacy Commission! The commission assists members in providing high-quality, cost-effective care while maintaining financially viable practices. Find the details on our PAFP Leadership page.
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Join the Practice Advocacy Network
We’re looking for practice administrators and office managers to join our workgroup focused on practice management and advocacy issues. Learn more here.
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Practice Advocacy Learning Sessions
The Practice Advocacy Network holds web-based learning sessions on issues that are important to you. Click here for a list of past presentations and materials.
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CURRENT PRACTICE ADVOCACY UPDATES
New Federal Requirements for CDL Medical Examiners
The National Registry of Certified Medical Examiners (NRCME) is a federal program that establishes requirements for health care professionals who perform exams for truck and bus drivers. Starting May 21, 2014 all medical examiners who wish to certify CDL drivers health must be certified and on the national registry--this involves training and fees.
Attestation still being accepted for enhanced Medicaid payments
Family physicians who wish to receive increased Medicaid payment rates for certain primary care services must now self-attest to the family medicine specialty and that they are either board-certified or billing at least 60 percent of services rendered to medical assistance (MA) patients of the specified E/M or vaccine administration codes. Initially, providers were instructed to just send board certification to satisfy the criteria.
Attestation and board certification documents can be submitted four ways:
- ePEAP: via the PROMISe provider portal
- Email: Ra-ProvApp@pa.gov (put "PCP" in the subject line)
- Fax: (717) 772-6765 (put "PCP" in the fax cover sheet subject line)
- Mail: DPW/OMAP/BFFSP, Attention: Provider Enrollment/PCP, PO Box 8045, Harrisburg PA 17105-8045
An attestation form and more information can be found on the Pa. Dept. of Public Welfare's website.
List of E/M Codes Eligible for Enhanced Medicaid Payment
According to the Medical Group Management Association (MGMA), a portion of the Affordable Care Act requires an increase in Medicaid payment rates to Medicare levels for certain primary care services in 2013 and 2014.
The following are codes are eligible: E/M codes 99201 through 99499 and vaccine administration codes 90460, 60461, 90471, 90472, 90473 and 90474 or their successors.
Additionally, MGMA reports higher payments for some E/M codes not reimbursed by Medicare: codes 99381 through 99387 (Patient/Initial Comprehensive Preventive Medicine); codes 99391 through 99397 (Established Patient/Periodic Comprehensive Preventive Medicine); codes 99401 through 99404, 99409, 99411, 99420 and 99429 (Counseling Risk Factor Reduction and Behavior Change Intervention); and codes 99441 through 99444 (E/M/Non Face-to-Face Physician Service).
For more information, please visit the MGMA's Affordable Care Act portal or The Federal Register (Nov. 6, 2012).
New Transitional Care Management Service Codes (TCM)
Medicare has begun allowing physicians to receive a payment separate from the E/M codes to help patients transition back into the community following an inpatient stay. These new codes are based on the complexity of medical decision making and the amount of time between discharge and the patient’s first face-to-face visit with the physician or other qualified health care provider. For both codes, it is required you have communication with the patient and/or caregiver within two business days of discharge. Code 99495 requires moderate complexity medical decision making and a face-to-face visit within 14 days. Code 99496 requires high complexity medical decision making and a face-to-face visit within seven days. AAFP has developed FAQ's and a worksheet to help you manage your transitional care patients.
Medical Record Copying Fee Limits Up Slightly in 2013
The per-page amount providers may charge for copying medical records will increase slightly in 2013. Patients may only be charged for copying and mailing costs, up to $1.42 (up 3 cents) per page for pages 1-20, $1.05 (up 2 cents) per page for pages 21-60, and 34 cents per page (no change) for pages 61 and up. Patients may not be charged for the cost of searching for and retrieving the medical record.
Avoid Payment Adjustments in 2015
Practitioners who begin participation now in the 2013 Physician Quality Reporting System (PQRS) incentive program and successfully report will avoid payment adjustments in 2015. For additional information on how to avoid these payment adjustments and get started click here.
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For more news and information, visit the PAFP Press Room and the PAFP News Archive, updated daily with news relating to health care and family medicine. |
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