Christina Thielst, Host of Christina's Considerations
Christina Thielst, Host of Christina's Considerations
I recently received a question via a referral from a friend and want to share it with my readers.
The scenario and question are:
My husband is an ER doc, board certified in Family Practice.  Under the ACA primary care physicians are eligible to receive the increased Medicaid reimbursement once they fill out the attestation indicating they meet the eligibility requirements.  However, in reading the CMS final rule, it seems to indicate that Emergency Room services (as well as OB) are not considered primary care.
He works for two ER contacting groups who are all over him to log on and do the attestation so they can receive the increased reimbursement.   A couple of things:
1.  We are both positive that even though he meets the criteria (primary care certified & 60% of designated codes outlined by CMS) having him complete the attestation is really skirting the intent.  He has never practiced outside of the ER and does not have a practice. CMS is not increasing the reimbursement for ACEP certified ER docs so this is really a technicality that the regulators didn’t anticipate.
2.  CMS indicates that a mechanism must be in place by the MCO to distribute the increased compensation back to the physician.  An ER group isn’t really an MCO.  My husband gets paid an hourly wage and they have no intent of increasing his pay based on the attestation.
Basically the push back is sign it or else. We were thinking perhaps he would sign it if the group agreed in writing to release him of all liability and indemnify him, and reimburse CMS if they decide to do a claw back down the road.  My fear is this all gets muddy and I can see CMS doing something crappy that nobody has thought of yet because nobody foresaw this little nuance.
I referred this individual to their local Regional Extension Center and encouraged her husband to obtain something in writing on whether he qualifies for attestitation.  If you have any other suggestions, please include them here as a comment.

By Christina Beach Thielst

First Posted at Christina’s Considerations on 11/26/2013

Christina Thielst, Host of Christina's Considerations
Christina Thielst, Host of Christina’s Considerations
Christina Thielst
Host, Christina's Considerations. A hospital administrator, consultant and writer with a passion for improving healthcare! Interests: the patient experience; health information, telehealth, social media, and mobile technologies; health information exchange; the business, environment and quailty of healthcare; workplace health and wellness; children and families; Louisiana and my family.


  1. It just keeps coming-dumping on the doctors, hospitals and patients. I’ve seen this complaint before about emergency room doctors not being covered. When this is combined with coverage for a person stops at the state line, it’s a recipe for disaster. I wrote advocacy groups about what happens to somebody like a trucker that constantly crosses state lines. Many are independents or have one to three trucks trying to start a business. They pay all of their own bills, and hopefully get reimbursed-sometimes they don’t. I was told that I didn’t understand that they had to negotiate with their insurance. On behalf of first responders that aren’t covered, the uninsured forest fire “HotShots” that don’t have insurance during the probation time, construction workers, people trying to find a job in another state, independent contractors in the film and computer industries—and all of the families that want to go to Grandma’s or Disney World—Thank you for telling them they need to pay extra premiums and that they might not have an ER to go to.


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