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Part B Insider (Multispecialty) Coding Alert

PHYSICIAN NOTES:

CMS Increases Physician Scarcity Area Incentives

Published on Thu Mar 24, 2005

Get bigger bonuses if you work in a critical access hospital

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

Find out if your zip code falls within a health professional shortage area (HPSA) county to determine whether you're eligible for this bonus, states an April 15 Centers for Medicare and Medicaid Services transmittal.

You can get the bonus if you provide services in a critical access hospital (CAH) 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 that you could get both the new physician scarcity bonus as well as the current HPSA bonus for a single service.

Important: 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.

To read the transmittal, go to www.cms.hhs.gov/manuals/pm_trans/R523CP.pdf.

In other news:  
 

  • CMS announced it would cover autologous stem cell transplantation (AuSCT) along with high-dose melphalan (HDM) for patients with primary amyloid light chain (AL) amyloidosis, according to an April 15 transmittal.

    Patients must have amyloid deposition in two or fewer organs, and cardiac left ventricular ejection fraction (EF) greater than 45 percent. Medicare will cover primary AL amyloidosis for all beneficiaries, regardless of age, who meet the above criteria. Medicare still doesn't cover all forms of non-primary AL amyloidosis, however.
     
  • A Hawaii court slapped the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and Hawaii Permanente Medical Group for fraudulently billing Medicaid, according to an April 14 state Attorney General's press release.

    An employee in Kaiser-Hawaii's dermatology department allegedly treated patients without a required state physician's assistant license. The company purportedly billed Medicaid for the employee's services. Also, the state alleged Kaiser didn't supervise the treatments properly. A whistleblower employee will receive $225,000 of the settlement, while MedQUEST, the state Medicaid program, was awarded $115,379. The remaining portion of the $900,000 will go to the Medicaid Investigations Recovery Fund.

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