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Medicare Primary Care Bonus Payment Program

Bonus Payment Program Overview

How will the bonus payments actually be made during the “payment year”?

Physicians who qualify for the bonus based on their specialty designation and the assessment of their billing during the prior period year, receive the bonus payment on the select primary care services they provide throughout the bonus payment year. This means that a primary care physicians for whom at least 60 percent of denominator-allowed charges are derived from select primary care services in 2009, will receive a 10 percent bonus payment on top of the Medicare payment for each select primary care service, i.e. office, nursing facility, domiciliary, and home visits, in 2011. Medicare will pay the bonus amount due to each qualifying physician after each 2011 calendar year quarter, with the amount being determined by the number of select primary care services that Medicare paid during that quarter. CMS states that the bonus payments will be made promptly at the conclusion of each quarter.

The Medicare contractor in each geographic area will post notice of the primary care physicians who qualify for each bonus payment year on its website. This will enable individuals to know if they will receive the bonus prior to the beginning of the payment year. It will also enable physicians to confirm their qualification even if their incentive payment is reassigned and paid to their group practice, a scenario in which the qualifying physician may not immediately know the earned bonus payments. You can find your contractor’s web address through the CMS website at http://www.cms.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip.

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