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 [...]