Increased Medicaid Payments for PCPs

increased medicaid payments


The US is facing an acute shortage of Primary Care Providers and the number of PCPs per 10,000 people has steadily been on the decline.

As part of the healthcare changes in 2013 which includes bringing millions of uninsured into the Healthcare net, Medicaid payments have been increased for qualifying Primary Care physicians for nearly 146 different Primary Care services for DOS on & after 1st January 2013 through December 2014. This increase is applicable in the states where Medicaid State Plan Amendment (SPA) has been approved.
Nearly 20 states have approved the Medicaid SPA so far and will pay higher reimbursement for qualifying physicians starting January 1st. For the states that are yet to approve Medicaid SPA, reimbursement will still be on 2012 rates for now but once the SPA is in place, all qualifying PCPs will receive the difference in payment in one or more parts.

This change will definitely improve the health care benefits for people who are below the poverty line in every state, especially for kids under Pediatric care.

Qualification for Physicians to become eligible for Increased Medicaid payments

  • PCP should be with a specialty designation of Family Practice, Internal Medicine and Pediatrics.
  • Should be certified by the American Board of Medical Specialties (AMBA), the American Osteopathic Association (AOA) or the American Board of Physician Specialties (ABPS)
  • Or 60% of the Medicaid claims from their previous year should be E/M codes specified.

Physicians can easily qualify on at least one of the above criteria. Physicians should have a positive outlook on this directive, as they will be receiving an increased and faster reimbursement on par with Medicare. And beyond doubt, the volume of patients seen by the PCP/ Practice on a daily basis will increase. So it is prudent for any provider/ Practice to get their billing done from a professional Medical Billing company and concentrate solely on patient care thus leading to higher reimbursement on time.

MGSI is a 22 yr old–national medical billing company based out of Tampa, FL. We provide services to over 600 Physicians in 15 states across the US and have expertise in more than 25 different specialties.

Being a premier organization in medical billing outsourcing, MGSI guarantees quality services along with a good return on investment with its revenue cycle management solutions. MGSI can manage the entire revenue cycle starting from Data Entry to AR f/up and Denial Management. MGSI also provides value added services like Fee Schedule evaluations, Managed Care Contracts Management and Physician Practice Management. Contact MGSI at

3 thoughts on “Increased Medicaid Payments for PCPs

  1. Vente en ligne New Balance Bleu Trianers

    Hey! Would you mind if I share your blog with my myspace group? There’s a lot of people that I think would really enjoy your content. Please let me know. Thanks

  2. jeremy

    Read four key takeaways for specialists within family medicine, internal medicine, and pediatrics and how they may be eligible for the payment increase.


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