August 7, 2013

State of Alabama
Press Release: Medicaid

Primary care physicians receive more than $8.8 million due to “bump"

Approximately 2,100 Alabama primary care physicians who qualified for an enhanced federal payment rate known as the “bump,” have received more than $8.8 million in additional reimbursement since the Alabama Medicaid received federal authorization on May 29.

The Agency began payment of the enhanced rate to qualified providers on June 8 and started reprocessing claims paid under the old rate in July so eligible providers could receive the difference for services provided since January. All reprocessing is expected to be completed by the end of September.

The increased reimbursement is the result of the Affordable Care Act which required state Medicaid programs to increase or “bump” up payments to certain physicians for specified primary care services beginning January 1, 2013.

The Affordable Care Act requires states to pay 100% of the Medicare rate for 2013 and 2014, or if higher, the Medicare rate for primary codes using the Calendar Year 2009 Medicare conversion factor. The increased payments – projected to be $39.6 million per year in Alabama – are funded entirely by the federal government for 2013 and 2014. However, the responsibility of maintaining the higher fees will fall to the state in 2015. 

Eligible physicians include board-certified family medicine, pediatric medicine, general internal medicine and related specialties or eligible physicians who can verify that 60 percent or more of the Medicaid codes they billed in the previous year were primary care codes and certain codes associated with vaccine administration listed in ACA. Health departments, federally-qualified health centers (FQHCs) and rural health clinics are not eligible for the fee increase.  

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