Medicaid Payment Increase for Pediatric Hematologist-Oncologists

By ASPHO posted 01-17-2013 12:34


Providing meaningful access to health services for children in the Medicaid program depends on appropriate payments for providers. Thanks in large part to recent pediatric advocacy, the Affordable Care Act (ACA) gives us the tools to do just that. The ACA increases Medicaid payment rates. Qualifying pediatricians and pediatric subspecialists will be paid at least 100% of Medicare rates in 2013 and 2014 for certain evaluation and management codes and immunization administration. The increase took effect at the beginning of this year, January 1, 2013.


Board-certified pediatric hematologists-oncologists automatically qualify for the payment increase. An American Academy of Pediatrics (AAP) analysis of billing data estimates that pediatric hematologists-oncologists stand to receive an average 30.8% increase in Medicaid revenue as a result of the increase.


We need your help to ensure the smooth implementation of this Medicaid payment increase on a state-by-state basis and to lay the groundwork for its extension beyond 2014. Here's what you can do:


Learn more about the Medicaid payment increase. Download a Medicaid fact sheet for your state, which includes information on how many children are enrolled in Medicaid and the difference between your state's Medicaid and Medicare payment rates. Read this  question-and-answer document generated by the AAP and this  question-and-answer document prepared by the Center for Medicare and Medicaid Services.


Discuss the payment increase with your practice or institution. Talk to your practice manager or institution's billing department to determine the impact of the payment increase on your practice, academic center or institution. Identify any implementation issues in your own state.


Consider the impact that increased payment could have on your ability to see more Medicaid patients. Increased access to specialists for children in the Medicaid program will help make the case for a long-term solution to the inequities between Medicaid and Medicare payment.


If you have questions about the payment increase, contact James Baumberger in the AAP Department of Federal Affairs.

This advocacy work is funded substantially by increasing membership among pediatric hematologists/oncologists in the AAP. We count on you to help us advance this important work. Join AAP or renew by calling 800.433.9016 x5897 with code N-ASPHO to take advantage of a special offer. Thank you.