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Medicare Monthly Review Part A and B
Medicare Monthly Review Part A and B
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National
Government Services, Inc. Medicare Monthly Review Part A and B |
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A
Combined Part A and Part B Newsletter |
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MLN Matters. . .Information for Medicare Providers |
Sunset of the Physician Scarcity Area (PSA) Bonus Payment
MLN Matters Number: MM5711
Related Change Request (CR) #: 5711
Related CR Release Date: August 24, 2007
Effective Date: January 1, 2008
Related CR Transmittal #: R1321CP
Implementation Date: January 7, 2008
Provider Types Affected
Providers billing a Medicare carrier, fiscal intermediary (FI), or Medicare Administrative Contractor (A/B MAC) for services provided to Medicare beneficiaries in physician scarcity areas
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 staffs are aware of these changes as listed in the Background section below and in the revisions to 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 CR5711. The Web address for accessing CR5711 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 five 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 CR5711 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 (CR5711) issued to your Medicare carrier, FI, or A/B MAC. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1321CP.pdf 
on the CMS Web site.
For the CMS Web site with information about HPSA/PSA (Physician Bonuses) and Zip code downloadable files you may visit http://www.cms.hhs.gov/HPSAPSAPhysicianBonuses/ 
on the CMS Web site.
If you have questions, please contact your Medicare carrier, FI, or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip 
on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.