Significant changes have been made in the areas categorized as Health Professional Shortage Areas (HPSA’s). The Health Resources and Services Administration (HRSA) published an updated Federal Register Notice on November 3, 2011, that contains important information about new and withdrawn HPSA designations. These changes will take effect for services provided on or after January 1, 2012. Although you have qualified for HPSA bonus payments in the past, this may not be the case in 2012.
For many years provisions have been in place to provide a 10 percent bonus payment to physicians who treat patients in these designated HPSA’s.
The 10 percent incentive amount is paid on a quarterly basis and is calculated based on the amount the Medicare program has paid for services furnished by the physician. Non-covered services and amounts applied to the deductible are not considered eligible for incentive payment since no payment was made by Medicare. It applies only to the professional component of those services. Eligibility for the incentive payment is decided by the location where the service is performed. If a physician provides services in an office, patient’s home, nursing home or hospital that is located in a HPSA area, these services are eligible for incentive payment.
A geographic HPSA may cover an entire county or only part of a county or city, depending on the health professional shortage in a designated area. This is an important distinction because the billing requirements will vary depending on this information.
The submission of the AQ modifier will be required for the following:
- When services are provided in ZIP code areas
that do not fully fall within a designated full-county HPSA bonus area. - When services are provided in a ZIP code area
that partially falls within a full-county HPSA but is not considered to be in
that county based on the dominance decision made by USPS. - When services are provided in a ZIP code area
that partially falls within a partial-county HPSA. - When services are provided in a ZIP code area
that was not included in the automated file based on the date of the data run
used to create the file.
The bonus will automatically be paid without the submission of a modifier when services are provided in ZIP code areas that either:
- Fall fully within a designated full-county HPSA.
- Fall fully within a full-county HPSA and have
been determined to be dominant for the county by the U.S. Postal Service
(USPS). OR - Fall fully within a partial-county HPSA
Use the following link(s) to verify HPSA eligibility:
- To verify automated HPSA bonus designation status: http://www.cms.gov/hpsapsaphysicianbonuses/.
- To verify HPSA bonus designation status: http://datawarehouse.hrsa.gov/geoHPSAAdvisor/GeographicHPSAAdvisor.aspx
If you have additional questions, your Medicare Administrative Contractor should be able to assist you.
