Medicare/Medicaid News

AAFP and GAFP Respond: We Are Fighting for a Medicare Fee Schedule that Works for Family Physicians

AAFP and GAFP Respond:  We Are Fighting for a Medicare Fee Schedule that Works for Family Physicians

Both the American Academy and the Georgia Academy have submitted a response to CMS’ proposed 2019 extensive rule change for Medicare payment.  The AAFP emphasized four points to CMS in its response to the proposed 2019 Medicare physician fee schedule: pay family physicians properly and slash their administrative burden, APMs are the best way to support family medicine, family physicians must be free to give patients the best care, and solo and small practices need better support.  To read the entire 80-page response from the AAFP click here:

In its letter, the Georgia Academy said in part:

Re:      CMS’ E&M Proposal Will Disproportionately Harm Small Practices

Support AAFP’s Proposed 15 Percent Increase for E&M Services by Primary Care Physicians

On behalf of the Georgia Academy of Family Physicians, I write in response to the proposed rule titled, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program” published by the Centers for Medicare & Medicaid Services (CMS) in the July 27, 2018, Federal Register.

The Georgia Academy commends your continued leadership and commitment to identifying and implementing policies that improve the Medicare program. We share your goals of reducing the administrative burden of modern medical practice and preserving independent physician practices. We support your stated goal of transforming the Medicare program into one that prioritizes the delivery of high-quality, patient-centered, comprehensive and efficient care.

We respectfully offer commentary on three high-level items for your consideration. The three items are:

  1. Priority Proposals in the 2019 Medicare Physician Fee Schedule
  2. Impact on Medicare Beneficiaries
  3. Impact on Solo and Small Physician Practices

To read the entire letter click here:

The AAFP and the GAFP will push out information to our members as soon as a final decision by CMS has been reached.  Also, the renowned coding expert, Steve Adams, will spend four hours (CME credit) at our Annual Meeting on Friday, November 9th breaking down the 2019 Medicare payment changes.  Sign up now to attend the annual meeting (and bring your practice administrator).  Click here to see more information and register for the meeting

CMS Study on Burdens Associated with Reporting Quality Measures

The Centers for Medicare & Medicaid Services (CMS) is conducting the 2018 Burdens Associated with Reporting Quality Measures Study, as outlined in the Quality Payment Program Year 2 final rule (CMS 5522- FC). Chapters may wish to share this information with members.

Clinicians and groups who are eligible for the Merit-based Incentive Payment System (MIPS) that participate successfully in the study will receive full credit for the 2018 MIPS Improvement Activities performance category. Applications for this study will be accepted through March 23, 2018 and will be notified in spring of 2018 if selected.

The study runs from April 2018 to March 2019. Study participants will have to meet the following requirements in order to complete the study and receive full Improvement Activity credit. For participants reporting as a group, their entire group will receive credit. For participants reporting as individuals, only the participating clinician will receive credit.

  • Complete a 2017 MIPS participation survey in April/May 2018.
  • Complete a 2018 MIPS planning survey in September/October 2018.
  • The Study team will invite selected participants to join a virtual 90-minute focus group between November 2018 and February 2019.
  • Meet minimum requirements for the MIPS Quality performance category by submitting data for at least three measures in the MIPS Quality performance category, as required for 2018 MIPS participation. The data submitted must:
  • Include one outcome measure;
  • Be submitted to CMS by the final MIPS reporting deadline (March 31, 2019);
  • Be submitted through any method accepted under MIPS for year 2 of the Quality Payment Program (2018).

For more information about the study or to apply(, please visit the CMS website( or email

Save the Date: Georgia Medicaid Fair

Dear Georgia Medicaid Providers and Stakeholders:

The Department of Community Health (DCH) and DXC Technology encourage you to save the following date for our next Medicaid Fair!

Wednesday, April 25, 2018
UGA Tifton Campus Conference Center

15 RDC Road

Tifton, Georgia 31794

The Medicaid Fair will open with important updates on emergent issues by DCH Leadership and over a dozen break-out sessions will cover a variety of topics. The Care Management Organizations will be onsite to answer your questions about their new contracts that are effective July 1, 2018. DCH and DXC Technology are also bringing back several 30-minute break-out sessions so you can get as much out of your Medicaid Fair day as possible. Please stay tuned for additional details registration information which will be posted soon.

Do you want to help shape our agenda?

To ensure that our planned break-out sessions (including time for questions and answers) address relevant topics for you, please submit your suggested breakout topics to no later than Wednesday, February 28, 2018. Based on your feedback the agenda will be developed and posted.

Do you need more information about UGA Tifton Campus Conference Center?

For location and directions to the Medicaid Fair, please visit the UGA Tifton Conference Center website at:

Thank you for your continued participation in the Georgia Medicaid program.

We look forward to seeing you on, Wednesday, April 25, 2018 in Tifton!


Georgia Department of Community Health

DXC Technology

Medicaid Changes – Effective July 1 – Check Patient’s Insurance

Dear Providers:

Beginning July 1, 2017, the Georgia Families® program will provide Members a choice of four Care Management Organizations (CMOs): Amerigroup, CareSource, Peach State Health Plan, and WellCare. Georgia Families® Members were given the opportunity to select a CMO during the Open Enrollment process which took place during the month of March 2017. Some Members who did not make affirmative selections were auto-assigned to a CMO. During the choice change period of July 1, 2017 through September 30, 2017, all Members will have a one-time opportunity to change their assigned CMO without cause. The change will become effective on the first day of the month after the change is requested. In order to ensure a smooth transition and that all Members have access to care, each CMO has implemented Transition of Care processes which include the following:

Existing/Open Prior Authorizations:

If you are rendering services to a Member who has a newly assigned CMO effective July 1, 2017, the newly assigned CMO will honor any current/open Prior Authorizations for forty-five (45) days beginning on July 1, 2017 through August 14, 2017. This applies to in-network and out-of-network (non-par) Providers. Thus, if you are rendering services to a Member who has a newly-assigned CMO, and you are not contracted with the newly-assigned CMO, the newly-assigned CMO will honor any current/open Prior Authorizations for forty-five (45) days beginning on July I, 2017 through August 14, 2017. If the Member requires services beyond August 14, 2017, Providers must contact the Member’s new CMO to obtain authorization to continue services. Providers will be required to follow the new CMO’s prior authorization process for any continued services the Member needs.

New Requests for Prior Authorization (i.e., requests submitted on or after July 1, 2017):

Providers will be required to submit new requests for Prior Authorization based upon the applicable CMO’s guidelines. This applies to in-network and out-of-network (non-par) Providers. Prior authorization decisions for non-urgent services will be made within three (3) business days. Expedited service authorization decisions will be made within twenty-four (24) hours.

Pharmacy-Related Prior Authorizations:

Each CMO will honor prescriptions ordered/issued prior to July 1, 2017. All current prescriptions (including medication step therapy) will be transitioned and honored by the new CMO for a period of forty-five (45) days, beginning on July 1, 2017 and ending on August 14, 2017. This is part of the Transition of Care process. Claims Reimbursement for Office Visits and Sick Visits for Out-of-Network Providers (Non-Par)


If you are rendering services to a Member who has a newly-assigned CMO effective July 1, 2017, and you are an out-of-network Provider, you may submit claims for reimbursement for office-based and sick visits rendered to Georgia Families® Members and Planning for Healthy Babies® enrollees without an authorization. Claims may be submitted to Amerigroup, CareSource, Peach State Health Plan, and WellCare by out-of-network Providers for services provided from July 1, 2017 through August 14, 2017. In all instances timely filing requirements must be met.

Please Note: Effective Friday, June 23, 2017, Providers will be able to submit CareSource PAs via the Centralized PA Portal. All PAs associated with the Centralized PA Portal will be processed for CareSource members beginning on July 1, 2017.

The following forms are currently associated with the Centralized PA Portal:
• Newborn Delivery Notification
• Pregnancy Notification
• Inpatient Hospital Admissions and Outpatient Procedures
• Hospital Outpatient Therapy
• Durable Medical Equipment
• Children ‘s Intervention Services
• Outpatient Behavioral Health

For any other CareSource PA submissions, please refer to https:/, call 1-855-202-1058, or email



Department of Community Health

View Georgia Families® Frequently Asked Questions & Answers

New Medicare cards offer greater protection to more than 57.7 million Americans

New cards will no longer contain Social Security numbers, to combat fraud and illegal use.

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition

Personal identity theft affects a large and growing number of seniors. People age 65 or older are increasingly the victims of this type of crime. Incidents among seniors increased to 2.6 million from 2.1 million between 2012 and 2014, according to the most current statistics from the Department of Justice. Identity theft can take not only an emotional toll on those who experience it, but also a financial one: two-thirds of all identity theft victims reported a direct financial loss. It can also disrupt lives, damage credit ratings and result in inaccuracies in medical records and costly false claims.

CMS is committed to a successful transition to the MBI for people with Medicare and for the health care provider community. CMS has a website dedicated to the Social Security Removal Initiative (SSNRI) where providers can find the latest information and sign-up for newsletters. CMS is also planning regular calls as a way to share updates and answer provider questions before and after new cards are mailed beginning in April 2018.

For more information, please visit: