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HPSA, PSA, Community Health Center & Other Resources
Medicare Health Professional Shortage Area and Physician Scarcity Area Bonuses
Health Professional Shortage Area (HPSA) Fact Sheet
New! CMS March 2010 Publication. (4-page PDF file; About PDFs)
How do I get the Health Professional Shortage Area (HPSA) or Physician Scarcity Area (PSA) bonus payment from Medicare?
The CMS HPSA/PSA Web site provides information on the HPSA/PSA bonuses.
Where can I find information on which areas are eligible for HPSA bonus payments?
This information is available on the Geographic Eligibility Advisor For Medicare HPSA Bonus Payments on the Health Resources and Services Administration (HRSA) Web site.
How are HPSA and PSA bonuses paid for services which have both professional and technical components? Must I bill each component separately?
Carriers use the information in the Professional Component/Technical Component (PC/TC) indicator field of the Medicare Physician Fee Schedule Database to identify professional services eligible for HPSA and physician scarcity bonus payments…
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0449.pdf (10-page PDF file; About PDFs)
When must I append modifier AR to a procedure code?
In some cases, a service may be provided in a county that is considered to be a PSA, but the zip code is not considered to be dominant for that area. The bonus payment cannot automatically be made. In order to receive the bonus for those areas, physicians must include the following modifier on the claim: AR - Physician providing service in a Physician Scarcity Area. (Source: Medlearn Matters Article SE0449)
When must I append modifier QB (physician providing a service in a rural HPSA) or QU (physician providing a service in an urban HPSA) to a procedure code?
If you provide care in zip code areas that do not fall entirely within a full county HPSA or partial county HPSA, you must enter either the QB or QU modifier on your claim to receive the bonus. (Source: Medlearn Matters Article SE0449)
How can I learn more or find answers to questions on Medicare payment for rural health services?
The Center for Medicare & Medicaid Services hosts Open Door Forum calls for the rural health community with important updates and question and answer sessions on topics such as HPSA and PSA status, cost reports, and more.
New! CMS March 2010 Publication. (4-page PDF file; About PDFs)
How do I get the Health Professional Shortage Area (HPSA) or Physician Scarcity Area (PSA) bonus payment from Medicare?
The CMS HPSA/PSA Web site provides information on the HPSA/PSA bonuses.
Where can I find information on which areas are eligible for HPSA bonus payments?
This information is available on the Geographic Eligibility Advisor For Medicare HPSA Bonus Payments on the Health Resources and Services Administration (HRSA) Web site.
How are HPSA and PSA bonuses paid for services which have both professional and technical components? Must I bill each component separately?
Carriers use the information in the Professional Component/Technical Component (PC/TC) indicator field of the Medicare Physician Fee Schedule Database to identify professional services eligible for HPSA and physician scarcity bonus payments…
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0449.pdf (10-page PDF file; About PDFs)
When must I append modifier AR to a procedure code?
In some cases, a service may be provided in a county that is considered to be a PSA, but the zip code is not considered to be dominant for that area. The bonus payment cannot automatically be made. In order to receive the bonus for those areas, physicians must include the following modifier on the claim: AR - Physician providing service in a Physician Scarcity Area. (Source: Medlearn Matters Article SE0449)
When must I append modifier QB (physician providing a service in a rural HPSA) or QU (physician providing a service in an urban HPSA) to a procedure code?
If you provide care in zip code areas that do not fall entirely within a full county HPSA or partial county HPSA, you must enter either the QB or QU modifier on your claim to receive the bonus. (Source: Medlearn Matters Article SE0449)
How can I learn more or find answers to questions on Medicare payment for rural health services?
The Center for Medicare & Medicaid Services hosts Open Door Forum calls for the rural health community with important updates and question and answer sessions on topics such as HPSA and PSA status, cost reports, and more.
Community Health Centers
What is a Federally Qualified Health Center?
Health centers are community-based and consumer-run organizations that serve populations with limited access to health care…
http://www.bphc.hrsa.gov/about/
How does a clinic qualify as a Rural Health Clinic?
The State Survey Agency reviews and evaluates the information on the Request to Establish Eligibility, Form CMS-29 and documents submitted with the request, and as necessary consults with the CMS Regional Office (RO) to obtain a determination whether the basic requirements are met…
http://www.cms.hhs.gov/CertificationandComplianc/18_RHCs.asp
Related Resources
A Model for a Successful Rural Practice
Family Practice Management; March 2000
Stark Law and Rural Health
Stark II, Phase III Changes Affecting Rural Health
- Adds a 45-minute transportation time test as an alternative to the 25-mile rule to the intra-family rural referrals exception;
- Adds a written certification option as an alternative to the requirement for a bona fide written offer under the exception for retention payments in underserved areas.
- Expands the exception for retention payments in underserved areas to permit retention payments to be made in the case of a physician who certifies that he or she has a bona fide opportunity for future employment and the arrangement satisfies all other conditions of the exception.
Rural and Underserved Safe Harbors under the Anti-Kickback Legislation
- Joint ventures in underserved areas
- Practitioner recruitment in underserved areas
- Sales of physician practices to hospitals in underserved areas
- Subsidies for obstetrical malpractice insurance in underserved areas;
Reimbursement, Coding/Billing, Special Funding
HPSA, PSA, Community Health Center & Other Resources
HRSA Office of Rural Health Policy Grants by State