Arkansas Medicaid Physician Quality Incentive

Through the Arkansas Physician Quality Incentive, Medicaid providers who meet or exceed EPSDT (Early and Periodic Screenings, Diagnosis and Treatment) thresholds have the opportunity to receive a bonus payment, in addition to regular reimbursement. Arkansas Medicaid PCPs, E3 and EPSDT specialties are eligible.

Launched in July 2007, PQI provides bonus payment thresholds based on your ratio of actual screens to expected screens. The expected number of screens is based on the number of Medicaid patients enrolled with the PCP during SFY 2007 and the number of months each patient has been enrolled. Your bonus is determined according to whether the screen ratio exceeds the compliance rate for each age group. A PCP could receive bonus payments for all age groups, some age groups or no age groups.

The total 2007-2008 budget for PQI is $1.5 million; $600,000 will be divided among eligible providers who perform screens, and $900,000 will be used to fund a two-tiered incentive payment system for PCPs whose caseload exceeds certain screening thresholds. Providers receive half the total bonus for reaching the initial threshold, and the other half if they exceed the higher secondary threshold. Financial incentives may not be available for providers who receive full cost reimbursement. For more information and an example of a typical reimbursement, view this Powerpoint presentation.

You can monitor your EPSDT rates easily using AMII, a secure Web portal where you can access specific information about your caseload. Find out more and register for AMII.

Physician participation in PQI is completely voluntary. PQI will not reward physicians based on their ranking compared with other physicians in the program. No penalties will be assessed to physicians who do not achieve the specified thresholds. The PQI bonus methodology follows the American Medical Association’s (AMA) Guidelines for Pay-for-Performance Programs.

To find out more, contact your MMCS provider representative.