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Medicare Primary Care Bonus Payment Program

Bonus Payment Program Overview

Does that mean that a physician who is newly enrolled in Medicare will have to wait until he or she has billed Medicare for two years to be able to receive bonus payments?

No, the “prior period” will be more current for physicians who recently enrolled in Medicare and have a more limited billing history. CMS will use the billing data it has for the calendar year immediately prior to the bonus payment year. For a physician newly enrolled in Medicare in 2010, CMS will use the 2010 billing data to determine bonus eligibility in payment year 2011. CMS will use whatever 2010 billing data is available, e.g. a physician who started billing Medicare in February 2010 would have more data than a physician who started billing in October 2010. CMS has placed no minimum requirement on the amount of data that must be available. A physician who is newly enrolled in Medicare in 2011 would have to wait until 2012 to receive bonus payments even if he or she is eligible using 2011 billing data. This means that a physician newly enrolled in Medicare once the bonus payment program starts will experience some lag time before receiving bonus payments. Once a physician has been billing Medicare for two years, CMS will use the same process for determining qualification as it uses for the physicians with the longer Medicare billing record.

ACP advocacy played a significant role in enabling primary care physicians newly enrolled in Medicare to be eligible for the bonus with less than a two-year billing history. The College stressed the importance of minimizing the new physician lag time to maximize the bonus program’s ability to increase interest in primary care practice. The agency responded by basing the eligibility calculation on the data available for the calendar year prior to the payment year. This means that the “wait time” for a new primary care physician will be less than a year (it would be significantly less for an individual who begins billing Medicare late in the year prior to the payment year) instead of the two years that CMS initially proposed.

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