National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Provider Types Affected
Physicians, and other providers, who bill Medicare contractors (fiscal intermediaries (FI), carriers, or Medicare Administrative Contractors (A/B MAC)) for providing services to Medicare beneficiaries in designated physician scarcity areas

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 MAC) 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 AR modifier and make the appropriate bonus payment.

Additional Information
You can find the official instruction, CR 5937, issued to your FI, carrier, or A/B MAC by visiting http://www.cms.hhs.gov/Transmittals/downloads/R1434CP.pdf on the CMS Web site. 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.

If you have any questions, please contact your FI, carrier, 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. CPT only copyright 2007 American Medical Association.