Medicare Compliance & Reimbursement

Why some will benefit from the physician shortage.

Good news for rural physicians. They could gain as much as 15 percent extra on their Medicare reimbursement next year.
 
From January 2005 until the end of 2007, Medicare will pay an extra 5 percent to physicians working in Physician Shortage Areas (PSAs) on top of the 10 percent bonus physicians may be receiving if they work in Health Professional Shortage Areas (HPSAs), according to the proposed physician fee schedule for 2005. The two designations aren't exactly the same, so some docs may receive just the PSA bonus or just the HPSA bonus, but some may receive the full 15 percent.
 
Physician shortage areas are determined by looking at the ratio of Medicare beneficiaries to primary care docs, and also to specialty care docs. Areas will mostly be determined by zip code, and payments will be based on the location where service is provided.
 
Also, many physicians will no longer be required to use a special modifier to identify themselves as HPSA doctors. Instead, the Centers for Medicare & Medicaid Services will identify these doctors automatically. But where this isn't possible, CMS will post a list of HPSAs on its Web site so affected doctors can continue to bill modifiers.
 
Lesson Learned: Rural doctors could see a significant fiscal lifeline thrown their way in 2005.