CMS Incentive Payment Information
Program Information
Quarterly and annually, CMS issues special incentive payments to EPs that participate in the following incentive programs.
Providers are welcome to use the information below to familiarize themselves with the various incentive plan requirements and payment policies.
Quarterly Incentive Payments:
- Health Professional Shortage Area (HPSA)
- Merit Based Incentive Payment System (MIPS)
- Promoting Interoperability/Meaningful Use
HPSA
HPSA is an incentive program for physicians who provide covered professional services in a rural or urban health professional shortage area.
- Eligibility for receiving the 10% bonus payment is based on whether the specific location at which the service is furnished is within an area that is designated as a HPSA. The key to eligibility is not that physician’s office is in a HPSA or that the beneficiary lives in a HPSA but where the services are rendered.
- CMS provides a list of ZIP codes that are considered HPSA area in the Downloads section of the Physician Bonuses web page.
- There are three types of geographic based HPSAs – primary care, mental health, and dental. We do not recognize dental health.
- HPSA bonuses pertain only to physician’s professional services. If a service is billed that has both a professional and technical component only the professional component will receive the bonus.
- To be considered for the bonus payment, the name, address and ZIP code of the location where the service was rendered must be on all claims (line item 32 or its electronic equivalent).
- Modifier AQ should be billed when providing an eligible service in a HPSA not on the automated ZIP code list.
- Physicians should verify the eligibility of their area by reviewing the designation files on the CMS website before submitting services with the HPSA modifier.
- Services submitted with the HPSA AQ modifier are subject to be validated by the contractor.
- Services with an AQ modifier may be subject to a post-payment review.
- Additional information regarding HPSA may be found on CMS’ Physician Bonuses webpage.
MIPS
The last program year for PQRS was 2016. PQRS transitioned to MIPS under the Quality Payment Program (QPP).
Visit the CMS QPP website for participation, reporting, and performance category requirements.
Questions related to the QPP can be directed to CMS:
- Monday- Friday 8:00 a.m.-8:00 p.m. ET
-
- 866-288-8292 (TRS: 711) when dialing 711, you will automatically be connected to a TRS Communications Assistant who will relay your conversation to the help desk agent with strict confidentiality.
- Email: QPP@cms.hhs.gov
Promoting Interoperability/Meaningful Use
Formerly known as EHR Incentive Programs, the Medicare Promoting Interoperability (PI) Programs provide incentive payments to eligible professionals, hospitals, and critical care hospitals that adopt, upgrade, implement, or demonstrate meaningful use through the use of certified PI technology.
Visit the CMS Promoting Interoperability Programs web page for program requirements. Medicare and dually eligible hospitals participating in the Medicare and Medicaid Promoting Interoperability Programs may contact the QualityNet help desk for assistance at qnetsupport@hcqis.org or 866-288-8912.
Reviewed 9/11/2024