Some Kentucky primary care physicians who received enhanced primary care payments or incentives for Medicaid in 2013 and 2014 have been asked to return a portion of those payments—in some cases, thousands of dollars.
Those incentive payments were, in many cases, a lifeline that allowed many primary care physicians to continue providing treatment to the exploding Medicaid population in Kentucky.
The incentive payments were part of the Affordable Care Act and paid Medicare rates to some physicians who provided eligible primary care services—evaluation and management and vaccine services—to Medicaid patients. Those incentive rates were higher than the usual Medicaid-established rates for services provided from Jan. 1, 2013, to Dec. 31, 2014. These rates are commonly referred to as enhanced primary care payments or incentives.
To receive the money for this initiative through federal funds, Kentucky submitted a State Plan Amendment that detailed how the more than $65 million (statewide) in enhanced payments would be paid to more than 3,300 eligible primary care physicians. Managed care organizations were required to report payments made to physicians to justify any adjustments to the capitation rates paid under their contracts. The enhanced payments were paid on a quarterly basis based on calculations the state made from claims data provided by the MCOs.
Any KMA member who receives a recoupment letter and needs assistance is encouraged to contact KMA’s Medical Business Advocacy Manager Lindy Lady at email@example.com.