Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5711 that reminds physicians that the PSA bonus under Section 413(a) of the Medicare Modernization Act (MMA) will sunset after December 31, 2007.
What You Need to Know
The PSA bonus is payable for dates of service January 1, 2005, through December 31, 2007. The PSA bonus is not payable for dates of service after December 31, 2007.
What You Need to Do
Make certain that your billing staff is aware of these changes as listed in the Background section below and in the revisions to the Medicare Claims Processing Manual chapter 4, sections 250.2.1, 250.2.2 and 250.3.2. The revised manual sections are attached to the official instruction in CR 5711. The Web address for accessing CR 5711 is in the Additional Information section of this article.
Background
Section 413(a) of the Medicare Modernization Act (MMA) requires Medicare to pay an additional 5 percent bonus to physicians rendering service in a designated PSA. Physician scarcity designations are based on the lowest primary care and specialty care ratios of Medicare beneficiaries to active physicians in every county or the lowest primary care and specialty care ratios of Medicare beneficiaries to active physicians in each identified rural census tract. The bonus payment is based on the amount actually paid, not the amount Medicare approved for each service. The Key Point of CR 5711 is that the PSA termination date is December 31, 2007 and is not payable for dates of service after that date.
Additional Information
For complete details regarding this issue, see the official instruction,
CR 5711 (PDF, 219 KB), issued to your Medicare carrier, FI or A/B MAC.
For the CMS Web site with information about HPSA/PSA (Physician Bonuses) and zip code downloadable files you may visit
www.cms.hhs.gov/HPSAPSAPhysicianBonuses/.
If you have questions, please contact our office at (866) 332-7025.