More primary care physicians will be eligible for Medicare bonus

Approximately 80 percent of family physicians will be eligible for the 10-percent, quarterly Medicare bonus that goes into effect Jan. 1, 2011, thanks to recent changes in the eligibility rules for the Primary Care Incentive Program (PCIP) made at the urging of the AAFP and other primary care organizations.

The PCIP, established under the Patient Protection and Affordable Care Act, stipulates that primary care services must account for at least 60 percent of a primary care physician's total Medicare allowed charges in order for the physician to qualify for the bonus. Prior to the recent rule changes, only 59 percent of family physicians were estimated to qualify. Primary care physicians who provide fewer primary care services, perhaps because they practice in underserved areas that require them to provide a broader array of services, would not be eligible.

The Centers for Medicare & Medicaid Services has now said it will exclude laboratory, drug and durable medical equipment charges as well as physician hospital visits from the calculations, which will result in more primary care physicians being able to qualify. CMS noted that hospital inpatient consultation E/M services will not be removed from the calculation, however, because it believes these E/M services are not typically furnished by "true primary care practitioners."

The potentially bad news, of course, is that physicians' Medicare payments could drop 23.5 percent by the end of November unless Congress acts.

Posted at 12:03PM Nov 10, 2010 by Brandi White, Senior Editor  |  Comments[0]