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Fee-for-Service Rate Reductions

Fee-for-Service Rate Reductions for Physicians, Advanced Practice Nurses and Other Professional Services in the 2011-2012 OHA Budget

The Oregon Health Plan has to cut 11.2 percent from its budget, and will make cuts to provider payments to meet this bottom line. The reductions won’t be across the board, but will be focused on areas that DMAP thinks will have the least impact on patients. Notably, the proposed cuts (which still have to be approved by CMS), don’t amount to the 11.2 percent that needs to be trimmed from the budget. Administrative services have been cut by 19%, and they are counting on savings from HB 3650, the Health Systems Transformation Law to cover the rest of the gap.

The most notable exception to these reductions is for primary care services provided by a primary care provider. Legislators held this group of services harmless. (Note, if a primary care provider bills for a non-primary care service, they will see a rate reduction. Same if a non-primary care provider bills for a primary care service.)

To determine which providers are classified as primary care providers, and which services as primary care services they looked to provisions in the Patient Protection and Affordable Care Act related to reimbursement for primary care providers, as well as some other Medicare guidelines.

As listed on Page 9 of the packet above, OHA has defined "Primary Care Providers” as the following types of nurses.

  •  Advance Practice Nurse
  • Nurse Practitioner Clinic
  • Pediatric Nurse Practitioner
  • Obstetric Nurse Practitioner
  • Family Nurse Practitioner
  • Nurse Practitioner
  • Certified Nurse Midwife

OHA defined primary care codes as most evaluation and management codes, and immunization administration codes. On page 11 in the packet there is a list of these codes. Codes not on this list will be reimbursed at a conversion factor of $26, reduced from the current $27.82.


NPO Quarterly Meeting

10/16/2020 » 10/17/2020
43rd Annual NPO Education Conference

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