Medicare Compliance & Reimbursement

Docs in critical access hospitals eligible for payout.

If you are a physician whose county qualifies as a physician scarcity area, you could get Medicare's additional 5 percent bonus payment.

Physicians should find out if their practice's zip code falls within a health professional shortage area county to determine whether they're eligible for this bonus, states an April 15 Centers for Medicare and Medicaid Services transmittal. Presence In CAH Is Key A physician can get the bonus if she provides services in a critical access hospital within a designated physician scarcity area.

Physician scarcity determinations are based on the lowest specialty and primary care ratios of Medicare patients to physicians in every county or identified rural census tract. Medicare will pay the 5 percent bonus based on the claim amount actually paid, not the Medicare-approved payment.

Remember: Physicians could get both the new physician scarcity bonus as well as the current HPSA bonus for a single service.
 
Leave Q Mods Off Claims CAHs with zip codes that fully fall within HPSA counties don't need to use modifier -QB (Physician providing service in a rural HPSA) or -QU (Physician providing service in an urban HPSA) on claims to receive bonus payments.

Also: CMS extended a 10 percent bonus to psychiatrists who render services in a CAH located in a primary care or mental health HPSA.

Check it out online: To read the transmittal, go to www.cms.hhs.gov/manuals/pm-trans/R523CP.pdf.