Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Complete information about HPSA incentive payment
Health Professional Shortage Area Incentive Payment
The Omnibus Budget Reconciliation Act of 1987 established Medicare’s Incentive
Payment Program, which encouraged primary care physicians to work in underserved rural areas and to improve access to care for Medicare beneficiaries. It paid primary care physicians an incentive payment of five percent for services furnished to Medicare beneficiaries in Federally-designated Health Professional Shortage Areas (HPSA). Effective January 1, 1991, Congress increased the incentive payment to 10 percent and expanded eligibility to include physicians’ services in both rural and urban HPSAs.
Under Section 1833(m) of the Social Security Act, physicians (including psychiatrists) who furnish care in an area that is designated as a geographic-based, primary medical care HPSA and psychiatrists who furnish care in an area that is designated as a geographic-based mental health HPSA are eligible for a 10 percent HPSA incentive payment for outpatient professional services furnished to a Medicare beneficiary. The HPSA incentive payment is available only for the physician’s professional services. If a service is billed with both a professional and a technical component, only the professional component will receive the incentive payment. The incentive payment is based on the paid amount of the claim.
If the service is furnished in an area that is on the CMS list of ZIP codes that are eligible for the HPSA incentive payment, payments are automatically paid on a quarterly basis. The list of eligible ZIP codes is updated annually and is effective for services on or after
January 1 of each calendar year. An area may be eligible for the HPSA incentive payment but the ZIP code may not be on the list because:
1) It does not fall within a designated full county HPSA;
2) It is not considered to fall within the county based on a determination of dominance
made by the U.S. Postal Service;
3) It is partially in a sub-county HPSA; or
4) Services with dates of service on or after January 1, 2009 are provided in a Zip
code area that was designated as of December 31 of the prior year but are not on
the Zip code file.
In these situations, the physician must utilize an AQ modifier to receive payment for claims with dates of service on or after January 1, 2006. If the ZIP code of the place of service is not on the HPSA list for automated payment, eligibility must be verified with the Fiscal Intermediary or A/B Medicare Administrative Contractor before submitting a claim with the AQ modifier.
Where to Find Additional Information About Health Professional Shortage Area Incentive Payments
Additional information about HPSA incentive payments is available as follows: In Chapter 12 of the Medicare Claims Processing Manual (Pub. 100-4): http://www.cms.hhs.gov/Manuals on the CMS website; Eligible ZIP codes:
http://www.cms.hhs.gov/HPSAPSAPhysicianBonuses on the CMS website; Qualified HPSAs:
http://www.hpsafind.hrsa.gov on the Web; and Census tract of place of service:
http://www.ffiec.gov/Geocode/default.aspx on the Web.
Top Medicare billing tips
URIBEL- methenamine, sodium phosphate, monobasic, monohydrate, phenyls alicylate, methylene blue, and hyoscyamine sulfate capsule Uribel i...
procedure code and description 71250 - Ct thorax w/o dye - average fee payment - $180 - $190 71275 CTA chest (noncoronary) 71260 CT ...
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...