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Physician Bonus and Incentives

Health Professional Shortage Area (HPSA) and HPSA Surigical Incentive Payment Program (HSIP) Leaving the CGS site

Section 1833(m) of the Social Security Act provides bonus payments for physicians who furnish medical care services in geographic areas that are designated by the HRSA as primary medical care HPSAs. In addition, for claims with dates of service on or after July 1, 2004, psychiatrists (provider specialty 26) furnishing services in mental health HPSAs are also eligible to receive bonus payments. If a zip code falls within both a primary care and mental health HPSA, only one bonus will be paid on the service. Effective January 1, 2011 through December 31, 2015, physicians serving in designated HPSAs will receive an additional 10% bonus for major surgical procedures with a 10 or 90 day global period. This additional payment, referred to as the HPSA Surgical Incentive Payment (HSIP) will be combined with the original HPSA payment and will be paid on a quarterly basis.

Primary Care Incentive Program (PCIP) Tool

For primary care services furnished on or after January 1, 2011 and before January 1, 2016, a 10 percent incentive payment will be provided to primary care practitioners. CMS has provided CIGNA Government Services with a list of the National Provider Identifiers (NPIs) of the primary care practitioners eligible to receive the incentive payments.

Electronic Health Record (EHR) Incentive Progam Leaving the CGS site

The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA).

Physician Quality Reporting System (PQRS) Leaving the CGS site (Formerly know as the Physician Quality Reporting Initiative or PQRI)

It's not too late to start participating in the 2011 Physician Quality Reporting System. There are several opportunities to participate in the Physician Quality Reporting System program for 2011. Even if you have not started participating in the Physician Quality Reporting System, you may be eligible to receive an incentive payment equal to 1.0% of your total estimated Medicare Part B PFS allowed charges for covered professional services furnished July 1, 2011- December 31, 2011. Refer to the "How to Get Started" link on the URL above.

E-Prescribing (eRx) Incentive Program Leaving the CGS site

Eligible professionals may begin reporting the eRx measure at any time throughout the 2011 program year of January 1-December 31, 2011 to be incentive eligible, but must do so prior to June 30, 2011 to be exempt from the 2012 eRx payment adjustment. To become successful electronic prescribers for purposes of avoiding the 2012 eRx payment adjustment, eligible professionals must report the electronic prescribing measure for a required minimum number of unique electronic prescribing events via claims between January 1, 2011 and June 30, 2011. Refer to the "How to Get Started" link on the URL above.


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