Wednesday, May 6, 2015

Medicare's Primary Care Incentive Payment Program (PCIP) FQAs

Q1. What if I have changed Medicare claims processing contractors in the past two years?
A1. Medicare combines claims data for each NPI across all contractors and sites of services (for example, CAH and office) in the development of the national PCIP eligibility file. Each claims processing contractor handling claims in the PCIP payment year for an eligible NPI will make PCIP payments based on the eligible primary care services processed by that contractor and attributed to the eligible NPI in the PCIP payment year.

Q2. Whom may I contact if I have questions regarding my PCIP eligibility status?
A2. If you have questions regarding PCIP eligibility, you may contact your Medicare
claims processing contractor contact center support. They will be able to confirm your primary Medicare specialty designation and your percentage of primary care services in the claims year used for eligibility determination (for example, CY 2009 for the CY 2011 PCIP payment year).

Q3. Do I need to identify PCIP participation on submitted claims?
A3. No, services eligible for PCIP payment are identified based on the qualifying physician’s or NPP’s NPI on the claim and the CPT codes for eligible primary care services.

Q4. What if I am part of a physician group?
A4. If you are part of physician group, you are still eligible for primary care incentive payments if you qualify based on your own specialty and primary care percentage. The rendering eligible primary care physician’s or NPP’s NPI and the primary care services on the claim identify the services as eligible for PCIP payment.

Q5. What if I am a qualifying physician or NPP who has reassigned my Medicare billing rights to a Critical Access Hospital (CAH)?
A5. Primary care incentive payments will be made to CAHs of behalf of qualifying primary care physicians and NPPs. The rendering physician or NPP is identified on the CAH claim by the NPI in the “other provider” field and the eligible primary care services are identified by the CPT codes.

Q6. How often will PCIP payments be made?
A6. Primary care incentive payments will be made quarterly.

Q7. Will this incentive payment be coordinated with other bonus payments?
A7. Yes, PCIP payment will be made in addition to Medicare payment under other bonus
programs such as the Medicare health professional shortage area (HPSA) physician bonus
program. Incentive payments will be made with a “Special Incentive Remittance” so that eligible physicians and NPPs may identify which incentives were paid for specific services
furnished.

Q8. Will I receive a written notice from Medicare if I become eligible for the PCIP payment in future payment years?
A8. No, each PCIP payment year Medicare will provide a national PCIP eligibility file for contractors to post to their websites. Physicians and NPPs will continue to confirm PCIP eligibility for each payment year via this data file.

Q9. Will I receive written notice from Medicare if I become ineligible for the PCIP payment in future PCIP payment years?
A9. No, if you become ineligible for future PCIP payment years, you will not be contacted
by Medicare.

Q10. What if I have other questions regarding my PCIP eligibility status?
A10. Physicians and NPPs should contact their claims processing contractor with any questions regarding their eligibility for the PCIP.

Q11. Will my PCIP payment include a remittance statement?
A11. Yes, the PCIP is often an electronic payment, followed up with a paper report called the Special Incentive Remittance. The remittance is detailed, identifying all of the PCIP eligible services furnished by the PCIP identified practitioner for the previous quarter from which the CMS calculated the PCIP bonus payment for that practitioner. Currently the remittance does not include a summary statement that accumulates PCIP payments for each practitioner. However, no earlier than April 2012 the remittance will be modified to include a summary of total PCIP bonus by practitioner.

Q12. What if I feel that I have been incorrectly qualified as an eligible PCIP practitioner?
A12. If you feel that you have been incorrectly qualified as a PCIP eligible practitioner, you
many contact your Medicare claims processing contractor and request that the contractor
review your prior period claims history that resulted in an eligibility determination. If it is
determined that an error was made in your claims history, your contractor may accept the
return of your PCIP payment.

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