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Family Practice Coding Alert

CMS Automatically Pays 5-10 Percent Extra on These Services

Making these lists means you don't need modifiers, and you get more money You can eliminate the extra step of using a specialty designation modifier and still receive a bonus payment - if your ZIP code appears on one of two lists.

But family practices that don't make the cut may also qualify for scarcity service allotments in 2005. Here's how to determine your designation and filing guidelines. Surprise: You Could Qualify for Bonus Money Even if you think your family physician doesn't provide care in a health professional shortage area (HPSA) or in a physician scarcity area (PSA), you should double-check your eligibility. "Many coders are unaware that CMS now classifies their ZIP code as an HPSA and/or PSA," says Connie Woods, CPC, consultant with Joy Newby and Associates in Indianapolis.

Problem: If you don't know that you qualify as an HPSA and/or PSA, you could receive numerous denials. You'll file claims without taking the added coding guidelines these designations may impose, which will trigger denials, Woods says.

Benefit: Despite changing some reporting methods, such as ECGs, you'll receive more money for your designation. CMS pays a 10 percent bonus to physicians rendering services in HPSAs and 5 percent to physicians providing care in PSAs. Full-County HPSAs Don't Require Modifier You may no longer need to report a modifier on HPSA claims to receive the bonus. Your modifier -QB (Physician providing service in a rural HPSA) or -QU (Physician providing service in an urban HPSA) use hinges on your ZIP code. 

Old way: Prior to Jan. 1, 2005, FPs rendering services in HPSAs had to include modifier -QB or -QU on claims to receive the 10 percent bonus payment for providing care in these regions. New way: You will automatically receive your extra compensation without having to append a modifier, if your FP provides care in ZIP codes that fall entirely within a full-county or partial-county HPSA.

However, if you provide care in ZIP codes that CMS doesn't designate as full- or partial-county HPSAs, "you must continue to enter either the -QB or -QU modifier on your claim to receive the bonus," states the CMS article Medlearn Matters (SE0449). 5 Steps Reveal Your HPSA 'Q' Rule  To determine if you qualify for an automatic bonus and no longer need to use modifier -QB or -QU, search for your ZIP code in the file "2005 Primary Care HPSA." If your ZIP code is on the list, you don't need to use modifier -QB or -QU.

If you don't find your ZIP, you may still be eligible for the HPSA bonus. Your search isn't over until you complete two additional tasks:
  Go to your carrier's Web site for HPSA designations.
  Verify whether the location where you render [...]


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