The District of Columbia pays qualified providers for certain primary care and vaccine administration services at an enhanced rate that is equal to 100% of the Medicare fee schedule. The increased payment applies to both fee-for service and managed care claims. Practitioners who are paid through another provider such as a hospital or a federally-qualified health center are not eligible for the increased payment.
Eligible primary care providers include qualified Primary Care Physicians, Psychiatrists, Obstetricians/ Gynecologists (OB/GYNs) and Advanced Practice Registered Nurses (APRNs). To qualify for the increase in primary care payments, each physician must first self-attest that he/she is a physician with a specialty designation of family medicine, general internal medicine, pediatric medicine, obstetrics/gynecology, or psychiatry. In addition, each physician must self-attest that he/she is either Board-certified in an eligible specialty or that 60 percent of his/her Medicaid claims for the prior year (or for new practitioners, the prior month), were for the eligible Evaluation and Management (E &M) codes specified under DHCF rules. If you are a physician seeking the increased payment, you must complete Section II, IV and V of this form.
To qualify as an Advanced Practice Registered Nurses (APRNs), each APRN must self-attest that 60 percent of his/her Medicaid claims for the prior year (or for new practitioners, the prior month), were for the eligible Evaluation and Management (E &M) codes specified under DHCF rules. An APRN who practices under the supervision of an eligible physician may also be eligible for an increased payment rate. If you are an APRN seeking the increased payment based upon your supervising physician’s eligibility, your supervising physician must complete Section II, IV and V and you must complete section III. (Note: Physicians must complete a separate application form for each APRN under their supervision). On an annual basis, DHCF will review claims to verify that physicians and APRNS receiving higher payments meet the requirements for such payments. A false statement or false certification on this form may result in recoupment of any overpayments and prosecution for filing a false claim.