Medical Billing Blog

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Alabama Restores “Bump” in Medicaid Reimbursement Rates

By: Gilbert Johnston

The Alabama legislature recently passed a bill to restore higher reimbursement rates for certain medicaid providers.

The “bump” in Medicaid reimbursement first came about in 2013, as a requirement of the Affordable Care Act. From 2013-2014, the act required states to pay Medicare level reimbursement rates for certain Medicaid services. When the two-year federal mandate ended, Alabama elected to maintain the higher rates indefinitely.

That is, until July 31st of this year, when the Alabama legislature ended the “bump”, citing budgetary restrictions. Fortunately, this cutback lasted only two months, as the legislature recently voted to reinstate the higher rates, effective October 1st.

Providers looking to take advantage of these rates must meet certain qualifications and take appropriate action in order to participate:

First, providers must currently practice one of the following specialties (or a subspecialty within): family medicine, general internal medicine, or pediatrics.

Second, providers must be recognized in that specialty by one of the following boards: the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), or the American Osteopathic Association (AOA).

If not recognized by one of those boards: a provider must attest that 60 percent of their billed Medicaid procedures are for 1) certain specified procedure codes for evaluation and management (E&M) services, and/or 2) certain Vaccines for Children (VFC) vaccine administration codes.

Third, if the prior two conditions are met, providers must fill out the certification/attestation form (link below) and mail it, with proof of relevant board certification, to: HPES, PO Box 241685, Montgomery, Alabama 36124

Again, “bump” rates are effective as of October 1st, 2016. Providers will be eligible to receive higher reimbursement rates retroactive to October 1st, if the required forms are received and filed by HBE on or before October 31st. Providers whose forms are received and filed by HBE after October 31st, will not be eligible for retroactive reimbursement.


The Official Medicaid Statement
The Certification/Attestation Form

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The Valletta Group is a medical billing company committed to serving the true needs of physicians. Valletta makes it a priority to stay up to date on policy and rule changes that may affect its clients. Learn more about The Valletta Group’s services.

About the Author: Gilbert Johnston

Gilbert has nearly 15 years of experience in the medical billing industry. He's a Certified Healthcare Business Management Executive (CHBME), as recognized by the Healthcare Business Management Association (HBMA), the leading organization for Revenue Cycle Management professionals. He also has extensive knowledge in matters of compliance, including HIPAA and HITECH, having served as the Compliance Manager at Valletta for years.

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