Tailored Plans are set to launch on July 1, 2024. As a provider of physical health services, you and your teams need to know how and where to submit claims for payment of services rendered. 

Did you know?

The typical primary care physician caring for Medicare patients must coordinate care with 229 other physicians working in 117 practices?

The 2024 Final Rule from CMS (Center for Medicare and Medicaid Services) established a new code to ensure Primary Care Providers receive additional payment for the high-value visits they provide.

Provider Relief Fund (PRF) recipients who received one or more payments exceeding, in the aggregate, $10,000 during a Payment Received Period are required to report as part of the post-payment reporting process. The reporting portal is now open. If you received payments from the fund between April and June 2020 you are required to report prior to September 30th, 2021. 

In an effort to improve healthcare quality and reduce costs, many states and healthcare plans are adoption Value-based payments. These financial levers are being used to encourage AUD/SUD treatment in primary care settings. This program is designed to give you an understanding of how to apply harm reduction strategies for AUD/SUD in primary care setting, including quick interventions and next steps if patients are deemed in need of immediate intervention-crisis.

In an effort to ensure optimal access to care for Medicaid beneficiaries, to support providers during the recent COVID-19 surge, and to alleviate potential provider payment concerns, DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out of network flexibilities to providers who have not yet contacted with a PHP through Nov. 30, 2021. These flexibilities were originally expected to sunset on Aug. 30, 2021.   

What is the Request to Move to NC Medicaid Direct Process? 

In the April 2021 Medicare Secondary Payer MLN Booklet, CMS clarified the policy on accepting payments for services when another insurance is primary to Medicare. 

To learn more about Medicare Secondary Payer(MSP) billing and claims review the Medicare Secondary Payer MLN Booklet.  Common MSP coverage situations are listed in Table 1 (pp 5-8).

On March 19, 2021 the North Carolina Division of Health Benefits posted a bulletin outlining their Health Equity Payment Initiative. To support the North Carolina Department of Health and Human Services (NCDHHS) goals to achieve health equity, NC Medicaid is introducing an enhanced payment to Carolina Access primary care practices serving beneficiaries from areas of the state with high poverty rates. 

The Practice Support Team at Northwest AHEC has gathered topics and resources for you for the week. Check them out below. Let us know if you need more information!

Medicaid recently released the Temporary Clinical Policy Modifications: Payment for Health Opportunities Screening and Referral.