Incentive Payments for Indian Health Services (Rev. 1040, 09-11-06)

by  Jared Staheli
June 25th, 2015

In accordance with §1833(m) of the Act, IHS physicians who provide covered professional services in any rural or urban health professional shortage area (HPSA) are entitled to an incentive payment. IHS physicians providing services in either a rural or urban HPSA are eligible for a 10 percent incentive payment. It is not enough for the physician merely to have his/her office or primary service location in a HPSA, nor must the beneficiary reside in a HPSA, although frequently this is the case. The key to the incentive payment is where the service is actually provided (place of service). For example, an IHS physician providing a service in his/her office, the patient’s home, or in a hospital qualifies for the incentive payment as long as the specific location of the service is within an area designated as a HPSA. See Pub. 100-04, Medicare Claims Processing Manual, Chapter 4, §250.2, for information on billing and payment in a HPSA pertinent to FI claims.

Section 413a of the MMA requires that a 5 percent bonus payment be established for physicians in a designated physician scarcity area (PSA). Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §§90.4 and 90.5 contains more information on billing and payment in a PSA pertinent to carrier claims. See Pub. 100-04, Medicare Claims Processing Manual, Chapter 4, §250.2.1, for information on billing and payment in a PSA pertinent to FI claims.

A physician may be eligible for both the HPSA and PSA bonuses.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 19