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Health Professional Shortage Area (HPSA) Federal Law permits special payment for professional services provided by physicians in federally designated geographic Health Professional Shortage Areas (HPSAs). Physicians who provide covered Medicare services in rural or urban HPSAs are entitled to a ten percent additional payment. The Department of Health Resources and Services Administration determines which areas are considered to be qualified for designation as a HPSA. Eligibility for the incentive payment is based on provider specialty and the location where the services were rendered, not necessarily where the physician maintains an office. HPSA boundaries are based on census tracts, and in many cases do not coincide with routinely used boundaries such as ZIP codes or streets. Census tract information can be located at http://www.ffiec.gov/geocode/default.htm or http://factfinder.census.gov/home/saff/main.html?_lang=en. For the most current HPSA designations, you may access the Health Resources and Services Administration (HRSA) website at www.bhpr.hrsa.gov/shortage/ or directly at: http://hpsafind.hrsa.gov. HRSA is an agency of the U.S. Department of Health and Human Services that makes the designation determinations. Please check the CMS Web site at www.cms.hhs.gov/HPSAPSAPhysicianBonuses to determine whether the HPSA bonus payment will automatically be paid for services rendered in your area. Incentive Payment HPSA incentive payment is not included with individual claim payments. Instead a review is done on a quarterly basis of the finalized claims billed with the HPSA modifier. At the end of each quarter, the provider receives a complete list of the claims that were billed with a HPSA modifier. HPSA incentive checks are issued within 75 days after the end of each quarter. Payment is made to the provider identified in item 33 of the CMS-1500 claim form on both assigned and non-assigned claims. The incentive payment is ten percent of the paid amount for the professional services rendered (not the approved amount). Incentive is only paid on professional services. Services such as the technical component of a diagnostic test, clinical lab test, or other services that are technical by definition, are not eligible for HPSA incentive payments. All "global" service codes, which contain technical components, are ineligible for HPSA incentive payment. To obtain incentive payment, the professional service must be billed on a separate claim detail line. 01/17/2008 |
