Medicaid Participation

Since early 2011 the Primary Care Coalition has provided consulting services and technical assistance to eight Montgomery Cares clinics, to help them move toward becoming Medicaid providers.

462052739Funded by the Montgomery County Department of Health and Human Services through a grant from the Kaiser Foundation, The PCC first  assessed the challenges to Medicaid and Primary Adult Care (PAC) participation for Montgomery Cares participating clinics and developed and implemented a plan to help them overcome the identified challenges. In 2012 and 2013, the PCC secured additional funding from AmeriGroup and the Montgomery County Council to continue to support clinics as they prepare to become Medicaid providers.

The evaluation, performed by the PCC and SHR Associates—a practice management firm that has worked with the PCC and Montgomery Cares clinics on a number of projects—revealed several areas of need common to most of the clinics participating in the project. The project focused on these seven areas that would benefit all clinics and could begin to move clinics toward Medicaid participation:

  • Obtain Group and provider National Provider Identifier (NPI) numbers
  • Obtain Group and provider Maryland Medicaid numbers
  • Educate and prepare clinics to use the Medicaid Eligibility Verification System (EVS), an online and telephonic system for checking patient Medicaid eligibility and MCO affiliation.
  • Educate and prepare clinics to use the Online Medicaid Provider Search, a resource for finding Medicaid providers for patient referral (should the patient be Medicaid eligible).
  • Improve CPT Coding as chart reviews revealed medical chart documentation did not support CPT codes assigned for many of the charts audited.
  • Improve Charge Capture. The medical billing systems and electronic medical record currently in use frequently did not reflect all services provided. (Montgomery Cares requires only an Office Visit code and ICD-9 code for payment.)
  • Improve Medical Record Documentation: In addition to documentation frequently not supporting the CPT codes assigned, documentation had other issues that could affect Medicaid reimbursement such as:
    • Illegibiliy
    • Incomplete notes or poor documentation
    • Lack of consent forms or notation of patient education
    • Lack of provider signature or notes that results were reviewed by provider

By participating in this project, clinics gained a clearer understanding of Maryland Medicaid and the benefits of clinic participation for both the clinic as an organization and the patients. By the conclusion of the project several clinics were interested in continuing to work toward Medicaid participation. Each clinic was provided with an individual implementation plan with concrete and manageable steps to help them move forward.

The PCC continues to be an available resource for all Montgomery Cares clinics and is available to offer consulting services or technical assistance to clinics interested in becoming Medicaid providers.

For more information contact Barbara Eldridge,