[Provider] Increase in Payments for MaineCare Primary Care Provider Payments

[Provider Notification]

ATTENTION:  MaineCare Primary Care Providers

The following message is a letter from Tony Marple, Director of the
Office of MaineCare Services.  It is being mailed to all primary care
providers.

 

 

Dear MaineCare Provider, 

 

The Fiscal Year 08-09 State budget includes an $8.3 million (state and
federal) increase in physician payments.  The 2007 budget approved by
the Maine Legislature and signed into law by Governor Baldacci increased
MaineCare physician rates from 53% to 61.7% of Medicare's January 2008
rates.

 

The rate increase will affect professional physician services, including
cognitive and physician-performed procedure services that are billed
with CPT codes as fee-for-service.  Federally Qualified Health Centers
(FQHCs) and Rural Health Centers (RHCs) will not see a rate change.
Radiology services, which are already paid at a higher percentage of
Medicare rates than we are proposing, will also not see a rate change.
Hospital employed primary care physicians will be paid on an interim
basis on the new fee table, but settled to 89.7% of cost.

 

There will be two rulemakings to make the necessary changes to Section
90 of the MaineCare Benefits Manual.  An emergency rule is expected to
be adopted by mid-August and will be retroactive to July 1.  Payment of
the new rates will not occur until the rule-making process is complete.

 

When the rule is adopted, the claims system will use adjustment
functionality to capture the new rates for claims filed on or after July
1.  Providers will get a check for the difference between the new and
old rates for these claims.  For the adjustment feature to work,
providers need to submit claims using their usual charges (not the
MaineCare rate), unless specifically instructed by policy.  Please refer
to the MaineCare HCFA1500 and CMS1500 billing instructions on the web at
http://www.maine.gov/bms/providerfiles/provider_billing_manuals.htm

 

The new rates by procedure code are posted on the MaineCare website.
These can be viewed by selecting the News and Provider Meetings tab from
the home page and then the Primary Care Physician Rates headline under
"News You Can Use."  The direct link to these is
http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#p
rim

 

Thank you for serving MaineCare members.  

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

 
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