Feb 01

Medicare incentive payment program for primary care services

Section 5501(a) of the Affordable Care Act provides for an incentive payment for primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner.
The Primary Care Incentive Program (PCIP) payment will be paid on a quarterly basis in an amount equal to 10 percent of the payment amount for services under Part B.
Primary care physicians/Non-Physician Practitioners (NPPs) (physician specialty 08, 11, 37 and 38 or NPP specialty 50, 89 and 97) who furnish the following primary care services from January 1, 2011, through December 31, 2015, will be eligible for a quarterly 10 percent incentive of the payment amount for those primary care services under Part B.
Note: If eligible, a provider has the potential of receiving both the PCIP bonus as well as the already established Health Professional Shortage Area (HPSA) bonus.
Primary Care Services Codes
Key Points 
  • Primary care services must account for at least 60 percent of the allowed charges under Part B for the provider in a prior period.
  • If a group or practice bills for a primary care service, the primary care professional service must be rendered by one of the eligible providers and be reflected by the rendering National Provider Identifier (NPI) for the claim detail.
  • CMS will extract eligible providers by rendering NPI and provide contractors with the information at the beginning of each year. The two files listed below will be issued to Medicare contractors:
    • PCIP Eligibility File – Lists qualifying NPIs. Medicare contractors will post this file on their Web sites by the end of January of each year. The incentive will be calculated on the amount paid for each quarter for the codes billed by the Provider Transaction Access Numbers (PTANs) associated with each qualifying
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