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Next round of Medi-Cal ACA primary care rate adjustments forthcoming



February 07, 2018
Area(s) of Interest: Access to Care Health Care Reform 

The California Department of Health Care Service (DHCS) recently announced that the final round of retroactive interim payment corrections, tied to the primary care physician (PCP) rate increases called for under the Affordable Care Act (ACA), began on January 25, 2018. 


The first two weekly check-writes will be focused on physicians with a net-positive payout (situations where reprocessing of a physician’s eligible claims going back to January 2013 exceeds the recoupment of their previously paid interim payment amount). Adjustments in the third week will focus on physicians with a net negative amount owed (situations where reprocessing of a physician’s eligible claims going back to January 2013 results in an amount due back to DHCS).


DHCS issued interim payments to primary care physicians who attested to their eligibility under the ACA PCP rate increase. These interim payments were weekly lump sum payments with no claim detail. and were designed to be adjusted once the system was capable of accurately paying and reporting payments at a claim-line level.


Approximately 8,900 erroneous payment corrections letters (reference number P34925) were issued on January 29, 2018, to providers advising that this final payment reconciliation will incorporate adjustments including zero pay Medi/Medi crossover claims. DHCS will be contacting the most highly impacted practices to discuss how the final reconciliation will affect the practice.


In cases of financial hardship for an impacted physician, DHCS is willing to consider extended payment options. Physicians interested in discussing this option can contact Medi-Cal at (800) 541-5555.


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