HPSA Alert:
Earn 10% Bonus on Qualified Cardiology Services
Published on Mon Feb 01, 1999
Executive Summary: Many cardiology coders, who are located in urban settings, have heard about the 10 percent incentive bonus for physicians who treat Medicare patients in a Health Professional Shortage Area (HPSA), but they automatically presume that all HPSAs are located in rural areas. This incorrect assumption may be shortchanging their practice thousands of dollars per year in additional revenue. Your urban cardiology practice may also qualify as a HPSA. In this article, well tell you how to find out if youre entitled to the incentive bonus as well as how to code correctly.
Rural or urban, your cardiology practice may be eligible for the programs 10 percent incentive bonuses for certain services -- if you treat Medicare patients in a location designated by the Public Health Service as a HPSA. (Incentive payments are made for services on both assigned or non-assigned claims.)
Heres how to get your quarterly payment:
1. Determine HPSA status.
First, dont automatically eliminate your cardiology practice because it is in an urban setting. A HPSA is a HPSA whether its located in a metropolitan or rural area.
You could be in a HPSA and not even know it, says Sheila E. Sylvan, principal, IMPACT Medical Consulting in Atlanta. Some metropolitan HPSAs are as small as a city block.
For example, in the Bronx, Brooklyn, and Manhattan, HPSAs are identified by census tract numbers.
Your best bet is to call your states carrier and ask for a HPSA map, she advises. Then examine it carefully to see if your practice provides services within the designated areas.
Hani Seifin, MD, who practices cardiology in Carthage, TX, (a rural area) asks, Can I use the HPSA modifier for services rendered in my office, outpatient as well as in inpatient settings?"
Remember, your Medicare patients do not have to live in a HPSA, nor does your office or primary location have to be in a designated area. Its the point of contact between the physician and the provider that counts.
For example, if the cardiologist sees Medicare patients a in hospital, nursing home, skilled nursing facility, or patients home that is located within a HPSA, then services provided at that setting are subject to the bonus.
If your practice has a satellite facility, be sure to check its HPSA status as well, Sylvan says.
But, if you have an office in a HPSA, yet provide cardiology services outside the office, in a non-HPSA area, you would not be eligible for the incentive payment. Also be aware that, for HPSA purposes, it doesnt matter where your billing office is located.
If you do provide services in a location other than your main billing and/or mailing address, you must include the name and/or address of the other setting [...]
