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I recently received a question via a referral from a friend and want to share it with my readers.
The scenario and question are:
My husband is an ER doc, board certified in Family Practice. Under the ACA primary care physicians are eligible to receive the increased Medicaid reimbursement once they fill out the attestation indicating they meet the eligibility requirements. However, in reading the CMS final rule, it seems to indicate that Emergency Room services (as well as OB) are not considered primary care.
He works for two ER contacting groups who are all over him to log on and do the attestation so they can receive the increased reimbursement. A couple of things:
1. We are both positive that even though he meets the criteria (primary care certified & 60% of designated codes outlined by CMS) having him complete the attestation is really skirting the intent. He has never practiced outside of the ER and does not have a practice. CMS is not increasing the reimbursement for ACEP certified ER docs so this is really a technicality that the regulators didn't anticipate.
2. CMS indicates that a mechanism must be in place by the MCO to distribute the increased compensation back to the physician. An ER group isn't really an MCO. My husband gets paid an hourly wage and they have no intent of increasing his pay based on the attestation.
Basically the push back is sign it or else. We were thinking perhaps he would sign it if the group agreed in writing to release him of all liability and indemnify him, and reimburse CMS if they decide to do a claw back down the road. My fear is this all gets muddy and I can see CMS doing something crappy that nobody has thought of yet because nobody foresaw this little nuance.
I referred this individual to their local Regional Extension Center and encouraged her husband to obtain something in writing on whether he qualifies for attestitation. If you have any other suggestions, please include them here as a comment.