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Medicare Primary Care Bonus Payment Program

Bonus Payment Program Overview

I have received my Medicare bonus check for the first quarter of 2011, and it is much less than I expected, and much less than 10%? What is going on?

There are a number of reasons why Medicare primary care bonus checks for this first quarter were less than anticipated. These include:

  • Payments related to the Medicare primary care bonus are paid quarterly and are based on claims for defined primary care services that were delivered after January 1, 2011 and processed by the CMS contractor during that specific quarter. Thus, for the quarter from January 1 through March 31, 2011, physicians who have submitted claims in a timely manner will likely be receiving the bonus for services delivered to beneficiaries in January and February, and only for a portion of beneficiaries seen in March since those claims submitted towards the end of the month were likely not processed in time. The claims not processed in March will be credited for the bonus in the subsequent quarter.
  • The 10 % primary care bonus is based not on the total allowable charge for the service, but on the amount actually paid to the physician for the service by Medicare. Many beneficiaries will be affected by the $162 Medicare Part B deductible during the early part of the year, and since there is no Medicare payment to the physician for services delivered during this deductible phase, there is also no bonus attached to services provided during that phase. As the year progresses, reductions in expected bonus payment amount resulting from the deductible should significantly diminish.
  • Based on the “actually paid” methodology being used by Medicare for the bonus payment, the 10 % bonus also does not apply to the beneficiary’s 20 % copayment for the qualified primary care service. This factor was not considered by many physicians who were calculating potential estimated payments.

The bonus amount for the 2nd quarter of 2011 should be much higher, since it will include a full three months worth of payments (that includes the unpaid March payments and partial June payments) and will be less affected by the deductible issue.

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