Practicing in underserved area may qualify you for Medicare payment bonus

Q: I practice in a rural area with few other primary care providers, and I’ve heard that I might be eligible for a Medicare bonus. Is that true, and if so, how do I claim it?

A: You may well be eligible for such a bonus. Physicians providing services to Medicare beneficiaries in areas that the U.S. Health Resources and Services Administration has designated as primary care health professional shortage areas (HPSAs) as of December 31, 2012, are eligible for a 10% bonus payment for services furnished from January 1, 2013, to December 31, 2013.

It is your responsibility as the physician to determine whether you are furnishing  services in a geographic HPSA. Eligibility is determined annually based on the status of the designation as of December 31 of the prior year. Also, a physician or provider who was eligible for the bonus in 2012 may not be eligible for the bonus in 2013.

The following Web sites may be helpful in determining whether the area where you practice is a geographic primary care HPSA:

• http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx

• http://hpsafind.hrsa.gov/HPSASearch.aspx

• http://www.ffiec.gov/Geocode/default.aspx

The Centers for Medicare and Medicaid Services (CMS) publishes annually a list of ZIP codes in which the 10% bonus is paid automatically. Only areas where the entire ZIP code falls within the designated area at the time the list is developed are included.

Physicians and providers furnishing services in eligible areas that are not on the CMS list of ZIP codes for automatic payment of the bonus must use the AQ modifier to receive the bonus. Only physicians furnishing services in areas designated as of December 31, 2012, as a geographic primary care HPSA where the ZIP code is not on the list should use the modifier.

Information on the Medicare physician bonus program, including the list of ZIP codes eligible for automatic payment of the bonus, can be found on the physician bonuses Web site at www.cms.gov/Medicare/Medicare-Fee-for-Service-payment/HPSAPSAPhysicianBonuses/index.html?redirect=/hpsapsaphysicianbonuses/01_overview.asp.

The author is a healthcare accountant and business adviser in Houston, Texas. Send your money management questions to medec@advanstar.com. Also engage at: www.twitter.com/MedEconomics and www.facebook.com/MedicalEconomics.