ACA Payments Webinar March 5, 2014 Roger Barnes, Assistant Director

1. ACA Payments Webinar March 5, 2014 Roger Barnes, Assistant Director

2. ACA Physician Payments Effective January 1, 2013 through December 31, 2014 Family Practice General internal medicine Pediatric medicine Sub-specialties in each of the above specialties Self Attest to one of the following Board Certified in one of the above specialties At least 60% of paid CPT codes are of the qualifying CPT codes

3. ACA Physician Payments Web Portal for Self Attesting is scheduled to be live March 14, 2013 Web Portal will be on the DMA website http://www.ncdhhs.gov/dma/provider/ACA_Home.html Physician Assistants and Nurse Practitioners Must self attest and list their supervising physician Supervising physician must be a qualifying and attesting physician Must be directly supervised by the physician

4. ACA Physician Payments DMA will validate the attestations annually after the close of CY 2013 and CY 2014 No payments were made until the SPA approved approved: June 12, 2013 The Medicaid fee schedule is based upon the July 1, 2009 rates The Medicare fee schedule is either January 1, 2013 or the July 1, 2009 conversion factor, whichever is greater

5. ACA Physician Payments Per the Approved SPA; those physicians who successfully attest on or before June 30, 2013; payments will be effective for dates of service beginning January 1, 2013. For those physicians who successfully attest on or after July 1, 2013; payments will be effective for dates of service beginning on the date of attestation.

6. ACA Physician Payments Attestation under Board Certification is valid for the duration the ACA payment period as long as the certification is current. If Board Certification becomes invalid during the ACA payment period, the physician could re-attest under the 60% provision.

7. ACA Physician Payments Attestation under the 60% option; the physician is attesting that of all the billed and paid codes, at least 60% of the billed and paid codes are the ACA codes. DMA will verify this after the end of calendar years 2013 and 2014 by reviewing paid claims data.

8. ACA Physician Payments During the weekend of March 2, 2014, programming was implemented that corrects the payment to include the Health Check claims. Starting with the Checkwrite of March 11, 2014, the physicians will begin seeing reprocessing of claims back to July 1, 2013. This should be concluded by March 18, 2014. On the paper RAs only, the reprocessed claims will be listed in a separate section titled “SPL PRCS PRACTITIONER PROFESSIONAL ADJT ADJUSTED CLAIMS” and the claims will be reported with a new EOB code of 06040 - “CLAIM REPROCESSED FOR ACA ADJUSTED PAYMENT.”

9. ACA Physician Payments Stage two of the reprocessing of claims will be those claims that were paid by HPES between January 1, 2013 – June 30, 2013. DMA and CSC are currently working on this process, however, a target date has not been finalized. It is a priority that is completed as soon as possible. Providers will be notified prior to the reprocessing of the claims. On the paper RAs only, the reprocessed claims will be listed in a separate section titled "SPL PRCS PRACTITIONER PROFESSIONAL ADJT ADJUSTED CLAIMS" and the claims will be reported with a new EOB code of 06040 - "CLAIM REPROCESSED FOR ACA ADJUSTED PAYMENT."

10. Questions & Links The link to the Attestation Portal is: http://www.ncdhhs.gov/dma/provider/ACA_Home.html The link to the recorded Webinar is: https://dhhs.ncgovconnect.com/p46507654/