March 13, 2015
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims.
Before the rate increases were implemented, some practices had been instructed by DHCS to bill CHDP claims at their Medi-Cal rates. This caused concern – based on DHCS’s pricing logic of paying the lesser of Medicare’s rate or the billed charges – that some practices would not qualify for the retroactive increases once the systems were updated to process claims at the higher rates.
In response to concerns, DHCS developed a web portal to allow physicians to enter their usual and customary rates (UCR). However, DHCS then discovered an error in its web app that required physicians who entered their UCR data prior to November 26, 2014, to have to reenter their information.
Recently, the California Medical Association (CMA) has learned that CHDP providers practicing as part of a group will be required to re-attest as a group to get paid. Previously, physicians had been instructed to only attest as individuals.
An updated “NewsFlash” is in process to explain the additional steps that will be required for CHDP doctors who bill as part of a group or clinic in order to be paid. CMA will publish an update as soon as the DHCS NewsFlash is released.