Primary Care Coding Alert

Question: Our practice is in a rural area, but we don't always receive an HPSA bonus when our physician treats patients in their own homes. Is there any way to secure this reimbursement?


Arkansas Subscriber
Answer: The Centers for Medicare & Medicaid Services recently clarified that Health Professional Shortage Area (HPSA) bonuses are in fact applicable for services provided in the patient's home.

However, you may encounter difficulty receiving this payment when the location of the service differs from the address that the beneficiary has on file with Medicare.

Why this would happen: According to CMS, the carrier sometimes has a -representative payee address- or mailing address that doesn't reflect the patient's true location. In such cases, the address on file may not reflect eligibility for an HPSA bonus.

Solution: CMS has now ordered carriers to investigate the exact location of service for HPSA claims with a -home- place of service (POS 12). You can also expect that CMS will soon ask you to assist the carriers and document the exact location where your physician provides service for POS 12 claims. Answers to You Be the Coder and Reader Questions by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J.; and Victoria S. Jackson, practice management consultant with JCM Inc. in California.