Physician Scarcity Area (PSA) Bonus Payment: Dates of Service Extended
What You Need to Know
CR 5937, from which this article is taken announces the extension of the physician scarcity area (PSA) bonus payment for dates of service through June 30, 2008. You should make sure that your billing staffs are aware of this PSA bonus payment extension.
Background
Section 413(a) of the Medicare Modernization Act of 2003 (MMA) required the Centers for Medicare & Medicaid Services (CMS) to pay a 5 percent bonus to physicians in a designated PSA for dates of service from January 1, 2005, through December 31, 2007. The Medicare, Medicaid and State Children's Health Insurance Program (SCHIP) Extension Act of 2007 amended Section 1833(u)(1) of the Social Security Act, extending the payment of the PSA bonus for dates of service through June 30, 2008. CR 5937, from which this article is taken, announces this extension and provides Medicare contractors with implementing instructions.
Medicare contractors will continue to pay PSA bonuses for dates of service from January 1, 2005, through June 30, 2008, regardless of whether the bonus is requested through submission of a modifier or made through an automated payment based on zip code. The primary care and specialty care scarcity areas in effect on December 31, 2007, will be used for 2008 services. Fiscal Intermediaries (FI) and Medicare Administrative Contractors (A/B MACs) processing Part A claims will implement this CR on January 7, 2008, and carriers and A/B MACs Processing Part B claims will implement it 30 days from issuance.
Carriers and A/B MACs processing Part B claims will identify claims that contain the AR modifier (physician providing services in a PSA) and are submitted with dates of service on or after January 1, 2008, and processed prior to this CR's implementation so that they may be included in the calculation in the first quarterly 2008 bonus payment. Additionally, when brought to their attention, carriers and A/B MACs processing Part B claims will reopen and reprocess claims with these dates of service that are processed prior to the CR's implementation date in order to include the HCPCS modifier AR and make the appropriate bonus payment.
Additional Information
You can find the official instruction, CR 5937 (PDF, 226 KB), issued to Palmetto GBA. The updated Medicare Claims Processing Manual, Chapter 4 (Part B Hospital (Including Inpatient Hospital Part B and OPPS)), Sections 250.2.1 (Billing and Payment in a Physician Scarcity Area (PSA)) and 250.2.2 (Zip Code Files); and Medicare Claims Processing Manual, Chapter 12 (Physicians/Nonphysician Practitioners, Sections 90.5 (Billing and Payment in a Physician Scarcity Area (PSA)) and 90.5.2 (Identifying Physician Scarcity Area Locations) are attachments to that CR.
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